| NPI | 1790755742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER JOHNSON Credentialing And Licensure Manager 314-447-7515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 07088917) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-05-12 |