| NPI | 1023148038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELKE SHAW-TULLOCH Division Administrator & State Heal 208-334-6996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2019-10-24 |