| NPI | 1770081010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE RACHELLE DEERING Owner 470-242-4675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: GA COSA049674) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2018-01-31 |