Organization
LICE AWAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNA MONTGOMERY (OWNER)
(337) 580-4027
Entity
Organization
Contact information
Practice address
100 BEAUVAIS AVE, LAFAYETTE, LA 70507-2468
(337) 466-8998
Mailing address
164 SAVOIE DR, EUNICE, LA 70535-6705
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
LA
Other
Enumeration date
03/28/2018
Last updated
03/28/2018
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