Organization
ITL PHARMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH R LATHAM (CEO)
(423) 444-1474
Entity
Organization
Contact information
Practice address
100 COLEY ST, KINGSPORT, TN 37660-1505
(423) 444-1474
Mailing address
100 COLEY ST, KINGSPORT, TN 37660-1505
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
00004115
TN
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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