| NPI | 1023063526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE BREWER Director 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 50000594A) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-12-15 |