Organization
NORTHWEST MEDICAL DIAGNOSTIC LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL JEROME LIAN MLT (CEO)
(360) 442-4129
Entity
Organization
Contact information
Practice address
1003 FIR ST, LONGVIEW, WA 98632-2526
(360) 442-4129
(360) 442-4130
Mailing address
1003 FIR ST, LONGVIEW, WA 98632
(360) 442-4129
(360) 442-4130
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
50D2098207
WA
Other
Enumeration date
05/11/2015
Last updated
01/29/2016
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