| NPI | 1790431211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CLARK LAWRENCE Cped 502-437-0134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 224L00000X Pedorthist |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2024-11-01 |