| NPI | 1639124423 |
|---|---|
| Other Name | MOUNTAIN STATE PROSTHETICS, LLC |
| Entity Type | Organization |
| Authorized Contact | DAVID P. HANSFORD Manager 304-344-5593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2012-03-15 |