Organization
SOLE SOURCE LLC YOUR DIABETIC SHOE STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE BOTTUM (SHOE FITTER)
(734) 340-9614
Entity
Organization
Contact information
Practice address
50 N HURON ST, YPSILANTI, MI 48197-2608
(734) 340-9614
(734) 879-2774
Mailing address
50 N HURON ST, YPSILANTI, MI 48197-2608
(734) 340-9614
(734) 879-2774
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/05/2012
Last updated
05/22/2012
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