NPI 1174983050

Roberta's Lovely Ladies Boutique

Organisation Mastectomy Fitter Alton, IL

Practice location

Address: 603 W. Delmar, Alton, IL 62002
Phone: (618) 467-0640

Authorised official

Name: Carol a Logan
Title: Owner
Phone: (618) 467-0095

Registered specialties

Mastectomy Fitter Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224900000X

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Registry record

NPI: 1174983050
Entity type: Organization
NPI issued: 4 Mar 2016
Record last updated: 4 Mar 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.