| NPI | 1811167059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA L LANE Billing Coding Specialist 803-649-2934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-08-05 |