| NPI | 1912543711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLIE JO PHILIPPSEN Owner 772-205-4138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2019-11-27 |