| NPI | 1003021890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP ANTHONY MINGA Member 662-256-4766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 760) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2009-10-22 |