Individual
EDILBERTO MONTENEGRO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5376 LAMBERT DR APT A, APT A, NORCROSS, GA 30093-4864
(470) 362-9008
(678) 400-7896
Mailing address
5376 A LAMBERT DR, APT A, NORCROSS, GA 30093
(470) 362-9008
(678) 400-7896
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/19/2014
Last updated
05/19/2014
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