| NPI | 1821781063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY CLINTON Ownerr 318-512-0170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2024-12-22 |