MARSHALL R BLACK

LEWISTON, ID
NPI1154357242
Professional NameMARSHALL R BLACK
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy222Z00000X Orthotist
Additional Taxonomies224P00000X Prosthetist
Enumeration Date2006-06-23
Last Update Date2007-11-02
Business Address
-- MARSHALL R BLACK CPO
823 16TH AVE
LEWISTON, ID 83501-3733
Phone number: 208-798-0200
Mailing Address
-- MARSHALL R BLACK CPO
823 16TH AVE
LEWISTON, ID 83501-3733
Phone number: 208-798-0200
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