| NPI | 1124495775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LEE BOUZIS Sole Member 307-265-3595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: WY 104611) |
| Additional Taxonomies | 122300000X Dentist (Licence: WY 104611) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2015-08-31 |