| NPI | 1881015931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM WAGNER Owner 812-438-2676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2014-07-25 |