| NPI | 1023202801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY AMYX MITCHELL Owner 870-424-6637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |