| NPI | 1972808202 |
|---|---|
| Doing Business As | SAME |
| Entity Type | Organization |
| Authorized Contact | TOMAS MICHAEL HERIC Medical Director 619-574-1144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-01-18 |