| NPI | 1225102684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WALLACE Director 601-426-4530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 06737) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2008-07-28 |