| NPI | 1811389059 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | SHANTEL TATUM Owner Practitioner 470-839-0797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2015-02-25 |