| NPI | 1689691495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP R KENNEDY Owner 770-220-9964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA 090106019697) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-10-02 |