| NPI | 1659730729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUNETTA LORRENE ROBERTS Owner 347-935-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 347C00000X Private Vehicle (Licence: VA t61856456) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2016-02-18 |