| NPI | 1902817117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE H. EVANCHO Owner 757-547-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 0103000375) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 179) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2009-12-03 |