| NPI | 1053185660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOWELL JACKSON OVERALL Manager / Principal 208-323-2727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-11-14 |