| NPI | 1124194857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED RONNIE MYRICK Owner 318-322-0995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2020-08-22 |