| NPI | 1487388427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEONDRA SHANTAY MCGRUDER Owner 706-513-9504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-14 |