| NPI | 1669427076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH R CLARK Owner 228-762-7776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 058264/11.1) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-01-31 |