| NPI | 1114920410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD G HEADLEY Owner 239-390-1077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL 1651) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2012-06-07 |