Organization
THE CLASSIC WIG BAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTE JACKSON (CEO)
(205) 703-6679
Entity
Organization
Contact information
Practice address
20250 N 67TH AVE APT 2107, GLENDALE, AZ 85308-6640
(205) 703-6679
Mailing address
15331 W BELL RD STE 2, SURPRISE, AZ 85374-4102
(623) 257-6655
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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