| NPI | 1871153585 |
|---|---|
| Doing Business As | FULL BLOOM NATURAL MEDICINE |
| Former Legal Business Name | MARY J BOUCHER, ND |
| Entity Type | Organization |
| Authorized Contact | MARY BOUCHER Dr. 541-224-6738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2019-12-09 |