| NPI | 1851071708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEISHA ANN KELLY President 904-942-1305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 224P00000X Prosthetist |
| 335E00000X Prosthetic/Orthotic Supplier | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2025-07-24 |