| NPI | 1063617629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL JACKSON Owner 843-542-9000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: SC 015090713) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2012-07-20 |