| NPI | 1790349850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MARIE KUCHARSKI-NELSON Manager/Secretary 704-900-9589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2023-08-30 |