Organization
ALICES BREAST PROSTHESIS SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICE C GARLAND (OWNER)
(815) 438-6481
Entity
Organization
Contact information
Practice address
1748 HOOVER ROAD, DEER GROVE, IL 61243-9738
(815) 438-6481
Mailing address
1748 HOOVER ROAD, DEER GROVE, IL 61243-9738
(815) 438-6481
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/06/2006
Last updated
01/04/2008
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