| NPI | 1154744407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH R PETERSEN Md/Owner 208-678-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2022-07-21 |