| NPI | 1679175988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN DELONEY Owner 636-590-4686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2024-01-25 |