| NPI | 1104983337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY L. STOUT Owner 708-771-4528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IL 0887330001) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2008-12-17 |