Organization
AFAHA M ASANGANSI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AFAHA MATTHEW ASANGANSI (OWNER OPERATOR)
(903) 509-3987
Entity
Organization
Contact information
Practice address
7524 S BROADWAY AVE, STE120, TYLER, TX 75703-5007
(903) 509-3987
(903) 509-9428
Mailing address
7524 S BROADWAY AVE, SUITE 120, TYLER, TX 75703-5007
(903) 509-3987
(903) 509-9428
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
161161801
TX
Other
Enumeration date
08/09/2005
Last updated
08/03/2011
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