TETON PATHOLOGY, PC
Medical Laboratory at Broadway Ave, Jackson, WY

License number
Wyoming 9164A
Category
Medical Laboratory
Type
Clinical Medical Laboratory
Owner
Name: DR. LARS CONWAY M.D.
Title: PRESIDENT
Phone: (612) 801-6060
Address
Address
625 E Broadway Ave, Jackson, WY 83001
National Provider ID: 1780027953
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Teton Pathology, PC

Jackson, WY

Registration:
Feb 15, 2013
Addresses:
625 E Broadway, Jackson, WY 83001 (Physical)
PO Box 4158, Jackson, WY 83001 (Mailing)
State ID:
2013-000638243
Business type:
Profit Corporation - Domestic
Expiration:
Perpetual

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