| NPI | 1841459880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY MUSIC Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2024-01-24 |