| NPI | 1336490119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER A MCGEE Owner Of Business 208-690-0364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: ID M11025) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: ID M11088) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2013-06-12 |