| NPI | 1962495119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA DEITRICK Director 217-535-3878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: IL 14D0710145) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2020-08-22 |