| NPI | 1619416120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY J STASCH Owner 620-275-4782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: KS 6077) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2017-02-16 |