| NPI | 1205988797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD GOERTZEN President 309-676-2276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IL 060008643213000063) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2024-03-20 |