| NPI | 1376040451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LEWIS Owner 217-877-1742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |