| NPI | 1639718422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VEDASWI BONDILI Owner 571-550-0759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2020-06-02 |