| NPI | 1033766613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL FREDERICK Md/Owner 125-485-7208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2021-09-29 |