| NPI | 1427226364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA V HENDERSON Proprietor 866-365-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: FL P00001685) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2012-01-21 |