Idalis INC
NPI #1184640591 in Lacey, Washington
Provider Information
- NPI Number
- 1184640591
- Entity Type
- Organization
- Organization Name
- Idalis INC
- Primary Specialty
- Psychiatry & Neurology - Neurology
- Enumeration Date
- Jul 15, 2006
- Last Updated
- Dec 10, 2007
Practice Location
- Address
- 3663 COLLEGE ST SE STE A
- City
- Lacey
- State
- Washington
- ZIP Code
- 98503-3529
- Phone
- (360) 413-1728
Authorized Official
- Name
- SAMUEL E COOR, DO
- Title
- OWNER
- Phone
- (360) 413-1728
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatry & Neurology - Neurology — Neurology |
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