| NPI | 1932290707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER JOHNSON Manager Of Credentialand Licensure 314-447-7515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AL 145) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-05-12 |