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1174983050
ROBERTA'S LOVELY LADIES BOUTIQUE
ALTON, IL
NPI
1174983050
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Entity Type
Organization
Authorized Contact
CAROL A LOGAN
Owner
618-467-0095
Organization Subpart ?
No
Primary Taxonomy
224900000X Mastectomy Fitter
Enumeration Date
2016-03-04
Last Update Date
2016-03-04
Business Address
ROBERTA'S LOVELY LADIES BOUTIQUE
603 W. DELMAR
ALTON, IL 62002
Phone number: 618-467-0640
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Mailing Address
ROBERTA'S LOVELY LADIES BOUTIQUE
603 W. DELMAR
ALTON, IL 62002
Phone number: 618-467-0640
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