| NPI | 1386428134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYVANA RUCKER President 315-455-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |