| NPI | 1629089792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES FREDERICK JACKSON Owner/Practitioner 307-637-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: WY C12686) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-04-04 |