| NPI | 1740532084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK D CROWDER Managing Member 702-836-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224L00000X Pedorthist (Licence: NV NV20121582347) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2012-10-10 |