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 |