| NPI | 1063854743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST H WALLACE Owner President 757-503-2196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-08-08 |