Individual
MS. CAROL DIANE BOULWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1615 SPRUCE ST, QUINCY, IL 62301-2060
(217) 242-3495
Mailing address
1615 SPRUCE ST, QUINCY, IL 62301-2060
(217) 242-3495
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2005038798
MO
Other
Enumeration date
08/28/2008
Last updated
08/28/2008
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