Organization
MINK TOTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY PHILLIPS (FULL LACE WIGS &FRONTAL SPECIALIST)
(843) 901-0824
Entity
Organization
Contact information
Practice address
3015 SCUBA DR, CHARLESTON, SC 29414-5696
(843) 901-0824
Mailing address
3015 SCUBA DR, CHARLESTON, SC 29414-5696
(843) 901-0824
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5889
SC
Other
Enumeration date
11/08/2017
Last updated
11/08/2017
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