| NPI | 1194026930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE I DIMAIO Owner 707-303-7261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224900000X Mastectomy Fitter |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CT CMF01542) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2019-11-12 |