| NPI | 1831312461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA W KLUTTS Practice Administrator 731-661-9825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD08163) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 0369490001) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2021-11-11 |