| NPI | 1124743695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE WEAVER Owner 337-540-7001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2023-02-06 |