| NPI | 1306030762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORISLAV KRESOVIC Designated Director 414-282-3634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: WI 004-0000158658-01) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: WI 004-0000158658-01) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2008-11-05 |