Organization
CROWN AND GLORY HAIR REPLACEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DESHONA MARIE WEST COSMETOLOGIST (CERTIFIED HAIR LOSS SPECIALIST)
(314) 467-0556
Entity
Organization
Contact information
Practice address
1474 STONEBURY CT, FLORISSANT, MO 63033-6109
(314) 467-0556
Mailing address
1474 STONEBURY CT, FLORISSANT, MO 63033-6109
(314) 467-0556
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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