Organization
ELEGANCE LACE WIGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIKISHA ROGERS (OWNER)
(919) 672-7912
Entity
Organization
Contact information
Practice address
401 NC HIGHWAY 54 APT B3, CARRBORO, NC 27510-2103
(919) 672-7912
(772) 673-7912
Mailing address
PO BOX 10032, CHAPEL HILL, NC 27515-0032
(919) 672-7912
(772) 673-7912
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/17/2010
Last updated
05/17/2010
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