| NPI | 1730400755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTAL D FULLER Owner 813-932-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL CE9977411) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2010-06-14 |