| NPI | 1053547083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN K JACOBS Director 904-541-0207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2009-06-04 |