| NPI | 1659591550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL JACKSON Owner 843-571-4646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: SC 010756087) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-04-29 |