Organization
ANTOINETTE'S WIGS & DAISY BOUTIQUE MASTECTOMY APPEARL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PATRICIA M LEDDY (OWNER/CERTIFIED FITTER)
(708) 385-5736
Entity
Organization
Contact information
Practice address
4714 147TH ST, MIDLOTHIAN, IL 60445-2527
(708) 385-5736
(708) 385-5754
Mailing address
4714 147TH ST, MIDLOTHIAN, IL 60445-2527
(708) 385-5736
(708) 385-5754
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
31674331
IL
Other
Enumeration date
10/13/2007
Last updated
10/13/2007
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