Organization
CRANIAL PROSTHESIS MEDICAL WIGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOREE WALTON (OWNER)
(612) 327-3493
Entity
Organization
Contact information
Practice address
8763 N ORANGE AVE STE 500, ORLANDO, FL 32801-2438
(612) 327-3493
Mailing address
8763 N ORANGE AVE STE 500, ORLANDO, FL 32801-2438
(612) 327-3493
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/15/2021
Last updated
04/15/2021
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