| NPI | 1427719558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYSE LEE LAKE Dpm, Owner 970-259-5303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |