| NPI | 1851768097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERN JOHNSON Owner 678-852-5272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: GA 11d2099839) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2025-01-23 |