| NPI | 1851045579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL A PEREZ Owner 662-299-9859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-02-10 |