| NPI | 1164178505 |
|---|---|
| Doing Business As | PROSTHETIC ORTHOTIC PROVIDER |
| Entity Type | Organization |
| Authorized Contact | NAKIMA VENISE MERCER Owner 386-991-1109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-02-24 |