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GENESIS DIABETIC SHOES & MEDICAL SUPPLIES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TANITA WALLACE (OWNER)
(910) 279-6181
Entity
Organization

Contact information

Practice address
3806 1/2 PARK AVE, WILMINGTON, NC 28403-6756
(910) 279-6181
Mailing address
608 WRIGHT ST, WILMINGTON, NC 28401-5722
(910) 279-6181

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
09/07/2012
Last updated
09/07/2012
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