| NPI | 1932672110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNIECE L JACKSON Owner 617-306-1809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-07-16 |