Organization
THE LACE WIG STORE AND SALON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DONNA RENA SINGLETON CRANIAL PROSTHESIS (OWNER)
(251) 300-8036
Entity
Organization
Contact information
Practice address
3202 DAUPHIN ST, MOBILE, AL 36606-4001
(251) 300-8036
Mailing address
3202 DAUPHIN ST, MOBILE, AL 36606-4001
(251) 300-8036
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
012455
AL
Other
Enumeration date
06/08/2009
Last updated
10/18/2012
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