Organization
ESSENTIALS SOUL-ON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEJUAN BURNS (OWNER)
(202) 802-3098
Entity
Organization
Contact information
Practice address
7902 OLD BRANCH AVE, 105, CLINTON, MD 20735-1646
(202) 802-3098
Mailing address
6600 HORSESHOE RD, CLINTON, MD 20735-2537
(202) 802-3098
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
425560
MD
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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