| NPI | 1932869237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAWANA RANDALL Manager 678-272-8180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QR0208X Clinic/Center, Radiology, Mobile |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2022-01-19 |