| NPI | 1194051300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK SHAWN NASH Presiden 314-363-7960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2009-10-22 |