| NPI | 1568871200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS TERRI DAVIS Cosmetologist 317-728-0045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IN BC107209275) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-08-07 |