| NPI | 1932364668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON LEE STARK Manager/ C.Ped 740-389-5775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2009-07-29 |