| NPI | 1720043342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVA DARLENE FORTSON Administrator 870-935-0519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2011-11-10 |