| NPI | 1124356993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTREAL C. GLOSSON Owner 920-257-6806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2009-12-05 |
| Last Update Date | 2009-12-05 |