Organization
RIVER BEND SHOE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GAWLITTA (OWNER)
(414) 543-0400
Entity
Organization
Contact information
Practice address
7508 W OKLAHOMA AVE, WEST ALLIS, WI 53219-2860
(414) 543-0400
Mailing address
7508 W OKLAHOMA AVE, WEST ALLIS, WI 53219-2860
(414) 543-0400
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
004000037355701
WI
Other
Enumeration date
01/08/2009
Last updated
01/08/2009
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