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Property and Equipment (Tables)
12 Months Ended
Dec. 31, 2018
Property, Plant and Equipment [Abstract]  
Schedule of property and equipment
    December 31,  
    2018     2017  
Land and land improvements   $ 2,452     $ 1,538  
Buildings     6,949       5,394  
Machinery and equipment     12,709       10,913  
Rental equipment     3,659       2,763  
                 
      25,769       20,608  
Less: accumulated depreciation and amortization     (11,667 )     (10,741 )
                 
    $ 14,102     $ 9,867