Organization
PARK PLACE DECLARANT
Active
Other names
Fabulous Hearing
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE KELLY MEMBER (OWNER)
(702) 807-7931
Entity
Organization
Contact information
Practice address
2105 MCCULLOCH BLVD N, #2, LAKE HAVASU CITY, AZ 86403-6772
(702) 807-7931
(702) 398-3757
Mailing address
PO BOX 224, LOGANDALE, NV 89021-0224
(702) 807-7931
(702) 398-3757
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
HAD5806
AZ
Other
Enumeration date
03/26/2009
Last updated
03/26/2009
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