| NPI | 1215534805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN DESKIN Owner 573-693-9818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171W00000X Contractor |
| 261Q00000X | |
| 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient | |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |