| NPI | 1063406189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY M KELLER Owner/Operator 231-933-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2011-09-30 |