| NPI | 1285962076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES CLAYTON BLALACK CEO 228-604-2155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 08614/11.1) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2018-11-29 |