Organization
MYIAHS MANE FACTORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JIAMYIAH GILMORE (OWNER)
(816) 888-0091
Entity
Organization
Contact information
Practice address
4410 SECRETARIAT DR, KILLEEN, TX 76549-4299
(816) 888-0091
(254) 246-7992
Mailing address
4410 SECRETARIAT DR, KILLEEN, TX 76549-4299
(816) 888-0091
(254) 246-7992
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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