| NPI | 1124465810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE WARD President 601-919-9196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TN 0000001106) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2015-05-27 |