| NPI | 1891547477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARRONICA STEWART Owner 601-462-1292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2024-04-05 |