| NPI | 1386214039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNETTE DUENOW Director Of Operations 907-230-9576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174200000X |
| Additional Taxonomies | 335G00000X Medical Foods Supplier |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-07-23 |