| NPI | 1326486242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON CLARK Manager 763-253-5679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2014-07-15 |