| NPI | 1104595420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRISCILLA CAPRISE DAVIS Owner 753-124-8234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2021-09-09 |