| NPI | 1407838717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY LYNN MOODY Manager 501-376-1975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2008-03-21 |