| NPI | 1255731386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MATUKEWICZ Secretary 423-756-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2016-03-11 |