| NPI | 1023366739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTY RAY FRIERSON Owner 678-520-3464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA 20170210145) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-08-28 |