Organization
LADY IN LACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAYE GROW (PARTNER)
(205) 349-5223
Entity
Organization
Contact information
Practice address
410 QUEEN CITY AVE, TUSCALOOSA, AL 35401-1552
(205) 349-5223
(205) 349-5217
Mailing address
410 QUEEN CITY AVE, TUSCALOOSA, AL 35401-1552
(205) 349-5223
(205) 349-5217
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
354846
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009902435
—
AL
01
—
56040
BLUE CROSS BLUE SHIELD
AL
Enumeration date
02/16/2007
Last updated
04/22/2008
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