Organization
THE WIG GALLERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA ANN PETRIE (OWNER)
(503) 255-3432
Entity
Organization
Contact information
Practice address
8401 NE HALSEY ST STE 101, PORTLAND, OR 97220-5670
(503) 253-5680
Mailing address
13918 NE MILTON ST, PORTLAND, OR 97230-2975
(503) 255-3432
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
06/02/2021
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