Organization
LADY GRACE STORES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE I GREEN (TREASURER)
(781) 322-1721
Entity
Organization
Contact information
Practice address
343 GORHAM RD, SOUTH PORTLAND, ME 04106-2317
(207) 774-8139
Mailing address
343 GORHAM RD, SOUTH PORTLAND, ME 04106-2317
(207) 774-8139
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/15/2009
Last updated
06/15/2009
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