| NPI | 1225109093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BENACKA Owner 763-420-4005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MN 150137200) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |