| NPI | 1235680976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ROGERS Owner 864-715-0688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: SC 4024) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |