| NPI | 1962150854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANISSA COX Cranial Prosthesis Specialist 309-453-7558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 174400000X Specialist |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-03-23 |