| NPI | 1053845842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIVANA EBONY WILLIS Owner 719-203-9581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |