| NPI | 1306935713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM LEISURE Owner 641-512-6118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IA ABCCPO1669) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |