Lady Grace Stores, Inc.
NPI #1700013935 in South Portland, Maine
Provider Information
- NPI Number
- 1700013935
- Entity Type
- Organization
- Organization Name
- Lady Grace Stores, Inc.
- Primary Specialty
- Prosthetic/Orthotic Supplier
- Enumeration Date
- Jun 15, 2009
- Last Updated
- Jun 15, 2009
Practice Location
- Address
- 343 GORHAM RD
- City
- South Portland
- State
- Maine
- ZIP Code
- 04106-2317
- Phone
- (207) 774-8139
Authorized Official
- Name
- BRUCE I GREEN
- Title
- TREASURER
- Phone
- (781) 322-1721
Specialties & Taxonomy Codes
| Specialty |
|---|
| Prosthetic/Orthotic Supplier |
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