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Organization

BRAVADAS FAIRFAX LLC

Active
Other names
Bravadas Wig Design
Organization subpart
No

Provider details

NPI number
Authorized official
KEVIN B LINEHAN (OWNER)
(703) 402-2826
Entity
Organization

Contact information

Practice address
11204 LEE HWY, SUITE A-1, FAIRFAX, VA 22030-5007
(703) 352-4247
(703) 403-0543
Mailing address
11204 LEE HWY, SUITE A-1, FAIRFAX, VA 22030-5007
(703) 352-4247
(703) 403-0543

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
11/29/2006
Last updated
02/06/2011
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