| NPI | 1417130055 |
|---|---|
| Other Name | VICKIS MASTECTOMY BOUTIQUE |
| Entity Type | Organization |
| Authorized Contact | VICTORIA MARIE GRAZIANO Owner 757-463-5844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2013-08-05 |