| NPI | 1760883102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA D ROARK Owner 229-292-9336 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CO COSA050783) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2014-09-04 |