| NPI | 1962769133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LEE NELSON Member 270-792-6832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |