| NPI | 1528243508 |
|---|---|
| Doing Business As | LADY M MASTECTOMY BOUTIQUE |
| Entity Type | Organization |
| Authorized Contact | GLADYS SMITH Owner 703-461-7534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: MD C18127) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-07-03 |