| NPI | 1164465878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE DENISE AGEE Practice Manager 251-343-5971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 00041) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2025-05-12 |