Organization
INCOGNITO WIGS NETWORK,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRI KAREN BACON LICENSED COMOTOLOGIS (OWNER/OPERATOR)
(573) 760-0837
Entity
Organization
Contact information
Practice address
103 W LIBERTY ST, FARMINGTON, MO 63640-1723
(573) 760-0837
(573) 760-0837
Mailing address
113 WEST LIBERTY STREET, FARMINGTON, MO 63640-1723
(573) 760-0837
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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