Organization
EXCLUSIVE GROOMING & HAIR REPLACEMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA DIANE SHARPE (OWNER)
(704) 500-1346
Entity
Organization
Contact information
Practice address
1414 FOREST PARK DR, STATESVILLE, NC 28677-7925
(704) 500-1346
Mailing address
PO BOX 5274, STATESVILLE, NC 28687-5274
(704) 500-1346
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
C63952
NC
Other
Enumeration date
06/17/2010
Last updated
06/17/2010
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