Organization
CRANIAL PROSTHESIS SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHYMINA LONG (OWNER)
(317) 556-3923
Entity
Organization
Contact information
Practice address
5126 N FRANKLIN RD, INDIANAPOLIS, IN 46226-2050
(317) 556-3923
Mailing address
5625 N GERMAN CHURCH RD # 3049, INDIANAPOLIS, IN 46235-8513
(833) 633-9447
(833) 633-9447
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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