| NPI | 1053458075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY P. NELSON Owner 660-665-9871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 620398800) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2008-09-18 |