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Organization
VENUS HAIR LOSS REPLACEMENT CENTER LLC
Active
Organization
VENUS HAIR LOSS REPLACEMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AKOSSIWA TATIANE AMENYO CERTIFIED (HAIR LOSS SPECIALIST)
(618) 401-6359
Entity
Organization
Contact information
Practice address
625 S LINCOLN AVE, O FALLON, IL 62269-2663
(618) 401-6359
Mailing address
625 S LINCOLN AVE, O FALLON, IL 62269-2663
(618) 401-6359
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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