| NPI | 1689739120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GENE RUCKER President 360-264-6553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 222Z00000X |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2008-02-04 |