| NPI | 1144363219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALIL LYNN CROUSE Owner 870-265-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2011-05-27 |