| NPI | 1659857019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE WILSON Owner 972-996-4565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 1002193) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |