| NPI | 1912537705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL EPIPHANY WILSON Licensed Cosmetologists 313-213-7443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-01-21 |