| NPI | 1871064055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | D'NELL S JACKSON Owner 469-352-8411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |