| NPI | 1790078210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATOSHA TYSON Representative 866-415-4210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 01782) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2011-05-17 |