Organization
CROWNING GLORY LACE WIGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM L ARNOLD (OWNER)
(312) 671-0516
Entity
Organization
Contact information
Practice address
8100 S STONY ISLAND AVE, UNIT F, CHICAGO, IL 60617-1734
(773) 356-9447
(773) 356-9447
Mailing address
8100 S STONY ISLAND AVE, UNIT F, CHICAGO, IL 60617-1734
(773) 356-9447
(773) 356-9447
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
06/24/2009
Last updated
06/24/2009
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