| NPI | 1053593129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MANUEL CARRILLO Owner 601-649-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-12-19 |