| NPI | 1699397158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISE WALLACE Member 248-496-6159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-05-07 |