| NPI | 1902141500 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP LAB- PHYSICIANS CLINIC |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2020-11-17 |