| NPI | 1588205132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDA STOCKTON Member Manager 772-877-7357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2020-03-26 |