| NPI | 1063835718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY HARRY ILCH Owner 804-370-0169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2014-01-31 |