| NPI | 1104079086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MICHELS Manager 623-466-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2008-10-23 |