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 |