| NPI | 1629368881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAXTER WRAY WALLS Owner 601-397-6386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2011-08-25 |