Organization
RENEW THE BREAST CARE BOUTIQUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LIGHT (VICE PRESIDENT)
(561) 876-4022
Entity
Organization
Contact information
Practice address
5601 OKEECHOBEE BLVD, SUITE C, WEST PALM BEACH, FL 33417-4489
(561) 328-7434
Mailing address
5601 OKEECHOBEE BLVD, SUITE C, WEST PALM BEACH, FL 33417-4489
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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