| NPI | 1013956077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY L DEDMON Owner 731-584-7919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 878) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 00878) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2018-02-09 |