| NPI | 1922509603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DANNELLY LOGUE Owner 443-487-4394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 222Z00000X |
| Additional Taxonomies | 224P00000X Prosthetist |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2018-02-27 |