| NPI | 1164200655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIPPLIN LASHAWN FORD Owner 904-424-3795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2023-09-18 |