| NPI | 1700075165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA D BOLTON Billing Manager 734-712-0635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2009-12-21 |