| NPI | 1801109012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK NOLAN CFO 651-312-3105 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2019-12-13 |