| NPI | 1861648958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY LEE PRINCE President/Owner 217-355-2680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 203.000084) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IL 203.000084) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2009-07-29 |