| NPI | 1154712321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY LAKE Office Manager 970-612-0476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-10 |