| NPI | 1023497054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADERINA MICHELLE LEE Owner 803-278-0605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management (Licence: SC 61556) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |