| NPI | 1255494787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L TILLMAN Owner 563-386-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 203000126) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2008-04-20 |