| NPI | 1508471335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISAIAH PARKS Owner 833-715-0726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-11-09 |