| NPI | 1912123795 |
|---|---|
| Doing Business As | BOSOM BUDDY BREAST FORMS |
| Entity Type | Organization |
| Authorized Contact | STACIE Q NEELY President 208-343-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |