| NPI | 1881643807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN WALLACE Administrator 704-332-5143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2025-07-10 |