| NPI | 1801130620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE LEIGHANN KMIEC Owner 281-292-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 224900000X Mastectomy Fitter |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2024-02-14 |