| NPI | 1851833933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES R EVANGER CEO 904-469-3119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6410) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2017-01-06 |