| NPI | 1477877934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONIA LEE VILLESCAS Sr Licensing & Credentialing Mgr 314-447-7515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID 003668305) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2025-03-21 |