| NPI | 1609019660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOSEPH GRIMES Pedorthist 918-855-1813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2010-10-11 |