| NPI | 1922012608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY LEE PRINCE President Owner 217-355-2680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2017-10-04 |