| NPI | 1306340476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WESLEY ANDERSON Owner 731-286-6006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: TN 87) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2018-03-22 |