| NPI | 1790714566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN IDEM ETUKO Director 651-639-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2020-08-22 |