| NPI | 1952668568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN BOE SIMMONS Owner 208-241-0876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID PA-272) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2012-04-19 |