| NPI | 1659801488 |
|---|---|
| Doing Business As | BOUTIQUE ON MAIN |
| Entity Type | Organization |
| Authorized Contact | COURTNEY STEVENS GARRISON President 704-225-0285 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 224900000X Mastectomy Fitter (Licence: NC CFm02947) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2017-06-28 |