| NPI | 1962412627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER FORMANEK President 225-756-0034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: LA PD321R) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-08-22 |