| NPI | 1548480866 |
|---|---|
| Former Legal Business Name | PROVIDENCE CENTRALIA LAB |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secreatry For Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2025-05-05 |