| NPI | 1316693765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE LEIGH WALCK Owner 607-296-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 224900000X Mastectomy Fitter |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-07-26 |