| NPI | 1295220762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WAYNE LATCH Owner 662-286-8064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 12758939) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-06-27 |