| NPI | 1740908417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY DEMETRIA BATES Certified Hair Loss Specialist 803-300-0273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |