| NPI | 1063030062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONDELL RICHARDSON Owner 704-510-2204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2023-11-03 |