| NPI | 1053495515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROLAND B WALL Manager 601-932-3815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-10-18 |