| NPI | 1912903717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY ELLIS Payer Relations Rep 802-734-6392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: RI 00343) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2022-12-14 |