Organization
PRINCESS CORSET AND LINGERIE SHOP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARLENE ANGELA JURGAITIS (PROPRIETOR)
(203) 755-3640
Entity
Organization
Contact information
Practice address
102 GRAND STREET, WATERBURY, CT 06702
(203) 755-3640
Mailing address
102 GRAND ST, WATERBURY, CT 06702-1909
(203) 755-3640
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/10/2010
Last updated
07/05/2012
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