| NPI | 1003087685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANCE TIMOTHY WALL CEO 678-985-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: SC 9181) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2016-06-24 |