| NPI | 1992420137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER LUSTER Head Store Manager 208-522-0599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2023-01-04 |