| NPI | 1104850965 |
|---|---|
| Doing Business As | TANNER BOUTIQUE |
| Entity Type | Organization |
| Authorized Contact | LEE C. SHERSETH CFO 770-836-9697 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 004396) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA 004396) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2009-03-17 |