| NPI | 1942429170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM B MCCORMICK Cfp 318-214-4350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: LA 208) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-06-26 |