| NPI | 1104475177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL CHARLES HURST Owner 803-468-7989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2020-08-04 |