Organization
CAROLS PERSONAL MASTECTOMY BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R STENQUIST (OWNER)
(801) 483-1262
Entity
Organization
Contact information
Practice address
3165 S MAIN ST, SALT LAKE CITY, UT 84115-3748
(801) 483-1262
(801) 483-1287
Mailing address
3165 S MAIN ST, SALT LAKE CITY, UT 84115-3748
(801) 483-1262
(801) 483-1287
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1744P3200X
UT
Other
Enumeration date
11/19/2007
Last updated
11/28/2011
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