| NPI | 1053895177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELASHA TAKETHA WALTON Hair Loss Specialist 706-461-1118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist Prosthetics Case Management |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2018-09-25 |