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Custom Brace Shop INC.

Durable Medical Equipment & Medical Supplies in Galesburg, IL. Organization (NPI-2).

NPI number1306865563
StatusActive
Last updated in NPPESJul 11, 2008

Details

NPI
1306865563
Entity type
Organization (NPI-2)
Legal business name
Custom Brace Shop INC.
Organization subpart
No
Enumeration date
Jul 19, 2006
Last updated
Jul 11, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
332B00000X Durable Medical Equipment & Medical Supplies––Yes

Practice location

872 W Dayton St
Galesburg, IL 61401-1503

Phone 309-344-5330 · Fax 309-344-5040

Mailing address

872 W Dayton St
Galesburg, IL 61401-1503

Phone 309-344-5330 · Fax 309-344-5040

Authorized official

Fakhry Wilson Azer
President /Owner
3093443400

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Other Durable Medical Equipment & Medical Supplies providers in Galesburg, IL

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