| NPI | 1104885367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN SHOTO Director Of Operations 662-247-1237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 03769111) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-08-22 |