| NPI | 1992160436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA JACKSON Administrative Director 267-566-2075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MD 2102105193) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2015-12-29 |