| NPI | 1720147218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA JEAN GENTILCORE Store Owner 860-432-7773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2008-07-10 |