| NPI | 1821381328 |
|---|---|
| Doing Business As | PARK MASTECTOMY SUPPLY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID PARK President 866-699-9612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2013-08-28 |