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Organization

HAIRFANATIC BOUTIQUE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARANDA BROWN DAVIS CERTIFIED HAIR LOSS (HAIR LOSS SPECIALIST)
(803) 730-0231
Entity
Organization

Contact information

Practice address
2757 LAUREL ST, SUITE 3, COLUMBIA, SC 29204-2037
(803) 730-0231
Mailing address
2757 LAUREL ST, SUITE 3, COLUMBIA, SC 29204-2037
(803) 730-0231

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
10/11/2016
Last updated
10/11/2016
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