| NPI | 1720034275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDON GROFF Administrator 210-340-2217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 0040222) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TX 0040222) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TX 0040222) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2022-03-09 |