| NPI | 1639352180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE A. JOHNSON Owner 262-723-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: WI 004-0002290200-01) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2008-01-14 |