Individual
JOHN WALTON BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
932 PEARL ST, BOWLING GREEN, OH 43402-2613
(419) 270-2774
Mailing address
932 PEARL ST, BOWLING GREEN, OH 43402-2613
(419) 270-2774
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
08/05/2010
Last updated
08/05/2010
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