| NPI | 1023446895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL BOURQUE Orthotist 386-323-7990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL ORT6) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2013-10-14 |