| NPI | 1639305709 |
|---|---|
| Doing Business As | SUPERMOMMY'S SUPERSTORE |
| Entity Type | Organization |
| Authorized Contact | REGINA RAE HAGAN Owner 270-769-6693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |