| NPI | 1144574138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS CARROLL FARRAR Owner/Operator/Dispenser 601-602-4147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: MS HA0502) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2017-05-01 |