| NPI | 1730327883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MATUKEWICZ Secretary 423-756-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: KY 131999) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2020-07-30 |