Organization
A BEAUTIFUL YOU MASTECTOMY BOUTIQUE
Active
Other names
A Beautiful You Mastectomy Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEANNE M KOVICK CFM (OWNER/OPERATOR)
(208) 985-5404
Entity
Organization
Contact information
Practice address
2006 BLAINE ST, CALDWELL, ID 83605-4343
(208) 985-5404
Mailing address
2006 BLAINE ST, CALDWELL, ID 83605-4343
(208) 985-5404
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CFM02746
ID
Other
Enumeration date
08/14/2014
Last updated
11/12/2014
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