| NPI | 1104950260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN EDWARD PRATER Office Manager 619-285-5040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0900X Clinic/Center, Amputee |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2025-09-11 |