| NPI | 1013952670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY O JACKSON Office Manager 307-237-3688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist Prosthetics Case Management |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2020-08-22 |