| NPI | 1821980996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNER TYSON Owner 601-441-8326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2025-07-15 |
| Last Update Date | 2025-12-18 |