| NPI | 1275675803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH MENVILLE Owner 225-215-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: LA 0600002125) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |