| NPI | 1972307940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE GONZALEZ Provider Enrollment Analyst 469-800-8742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2025-04-01 |