| NPI | 1477980811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DEWAIN WILSON Owner 601-498-6867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 12649/11.1) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2023-05-30 |