| NPI | 1720605215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY GLENN MOORE Owner 662-801-8314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2020-06-30 |