| NPI | 1609919521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MAE WILSEY Owner 225-910-8874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: LA 10-00524-504) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2014-04-04 |