Organization
LADY GRACE STORES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE IRA GREEN (TREASURER)
(781) 322-1721
Entity
Organization
Contact information
Practice address
1364 BEACON STREET, BROOKLINE, MA 02446
(617) 566-8194
Mailing address
5 COMMONWEALTH AVE, UNIT 1, WOBURN, MA 01801-1009
(781) 322-1721
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MA
Other
Enumeration date
05/12/2009
Last updated
05/12/2009
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