| NPI | 1528764784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALANDA K TILLMAN Provider 601-384-4532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-07-17 |