| NPI | 1487712113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW MOUTON Owner 708-364-9606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: IL 203000641) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-07-21 |