| NPI | 1467582288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA EUBANKS Controller 662-234-1520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: MS 04665) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |