| NPI | 1144381336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AGNES ROBERTA BLACKWELDER President Owner 386-274-3307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL 1313031) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |