Organization
VILLAGE SHOE SERVICE, LLC
Active
Other names
Village Shoe Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY WILLIAM SCHUPBACH JR. C.PED. (OWNER)
(770) 938-7463
Entity
Organization
Contact information
Practice address
4286 RAILROAD AVE, TUCKER, GA 30084-4487
(770) 938-7463
Mailing address
4286 RAILROAD AVE, TUCKER, GA 30084-4487
(770) 938-7463
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPED2232
GA
Other
Enumeration date
12/03/2008
Last updated
09/25/2009
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