| NPI | 1548512239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANESHA RACHELLE BOLER Manager 888-739-3126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2012-10-05 |