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 |