| NPI | 1164923298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON RIDGEL Owner / President 629-777-5252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2021-02-18 |