| NPI | 1235462391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY E HARRIS Owner 270-904-6130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: TN PRO0000000124) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2021-07-29 |