| NPI | 1841906047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATEISHA NICOLE FORT CEO 800-897-4575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2024-03-08 |