| NPI | 1720171929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL JACKSON Owner 843-571-4646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: SC 010748453) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-05-16 |