| NPI | 1093767923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT BUBOLO Owner 770-975-1299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 018938) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA PT006876) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 5860470001) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-01-27 |