| NPI | 1467150110 |
|---|---|
| Former Legal Business Name | REVIVING CROWNS SOLUTIONS |
| Entity Type | Organization |
| Authorized Contact | MARQUISHA SHANKEIA GENERAL Owner 770-580-2380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-03-13 |