| NPI | 1083166680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER JOHNSON Manager Of Licensure And Credential 314-447-7515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2016-10-30 |
| Last Update Date | 2024-06-26 |