| NPI | 1366653800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELENE MARIE ROBERTS Office Manager 208-233-3794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: ID 207ZP0102X) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2010-03-05 |