Roberta's Lovely Ladies Boutique

NPI #1174983050 in Alton, Illinois

Provider Information

NPI Number: 1174983050
Entity Type: Organization
Organization Name: Roberta's Lovely Ladies Boutique
Primary Specialty: Mastectomy Fitter
Enumeration Date: Mar 4, 2016
Last Updated: Mar 4, 2016

Practice Location

Address: 603 W. DELMAR
City: Alton
State: Illinois
ZIP Code: 62002
Phone: (618) 467-0640

Authorized Official

Name: MRS. CAROL A LOGAN
Title: OWNER
Phone: (618) 467-0095

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Mastectomy Fitter	224900000X	Primary

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