| NPI | 1205955754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM SAMUEL WALTER President 479-452-5419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: AR 03722765001) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AR 03722765001) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2011-12-14 |