| NPI | 1760008791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL ANNE FULLER Biller 469-395-8402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |