| NPI | 1427427004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MORIAH EICKHOFF Owner 308-221-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NE 1017) |
| Additional Taxonomies | 251S00000X (Licence: NE 816) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2017-05-09 |