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 |