| NPI | 1922007970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LARSON Owner 260-490-8485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IN 4811410001) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2020-08-22 |