| NPI | 1063564367 |
|---|---|
| Former Legal Business Name | LILBURN SHOE REPAIR AND PEDORTHICS INC |
| Entity Type | Organization |
| Authorized Contact | JACKIE YVONNE LEANDRO Owner 770-931-0823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 9914) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2021-02-17 |