| NPI | 1710401526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY CHANDASACK Member 817-586-4422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-07-21 |