| NPI | 1689352254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OUMOU K BAH Compliance & Medicaid Specialist 602-393-8188 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2023-07-05 |