| NPI | 1982685178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN G BOSTICK Supervising Physician 256-734-3141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: AL 01D0300133) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-08-31 |