| NPI | 1093837528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON FAGAN CFO 132-612-0209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO R1H47) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2022-02-23 |