| NPI | 1114141165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTIS W WILLEY Owner 870-336-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BD1200X Durable Medical Equipment & Medical Supplies Dialysis Equipment & Supplies |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2009-04-27 |