| NPI | 1942807425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM LAWRENCE BOUCHILLON Practice Manager 662-803-6086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2025-10-20 |