Organization
DIVA RESOURCE CONNECTION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYANDIE WALKER (OWNER)
(630) 303-8247
Entity
Organization
Contact information
Practice address
4807 W HARRISON ST, CHICAGO, IL 60644-5130
(630) 303-8247
Mailing address
2013 S 13TH AVE, MAYWOOD, IL 60153-3129
(630) 303-8247
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
07/20/2021
Last updated
07/20/2021
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