| NPI | 1972782431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DOUGHERTY Owner 918-609-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OK 104) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: OK 104) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2008-04-22 |