| NPI | 1902159817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONIA LEE VILLESCAS Sr Mgr Licensing & Credentialing 314-447-7515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2025-05-17 |