| NPI | 1871608695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN N COLE CEO/Director 208-472-1082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: ID 13D1020051) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-12-31 |