| NPI | 1669087045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY MORRISON Owner 417-777-0797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335G00000X Medical Foods Supplier |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-09-11 |