| NPI | 1528251758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD WILMONT MALLARD President 904-215-5951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |