Organization
PERFECTLY IMPERFECT WIG COLLECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUGGERA RUSSELL (OWNER)
(601) 201-5625
Entity
Organization
Contact information
Practice address
418 CARROLLTON AVE, LEXINGTON, MS 39095-3212
(601) 201-5625
(601) 476-6501
Mailing address
418 CARROLLTON AVE, LEXINGTON, MS 39095-3212
(601) 201-5625
(601) 476-6501
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/27/2020
Last updated
05/27/2020
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