| NPI | 1104415108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIQUE LYNETTE VAILES Owner 240-375-1670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2024-08-03 |