| NPI | 1568461655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G. LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL 1312625) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2019-08-20 |