| NPI | 1780646653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALLEN MANTEY Diabetic Shoe Program Facilitator 910-772-9994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: NC 00992) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2015-09-18 |