Organization
FAIRYTALE HAIR L.L.C
Active
Other names
Fairytale Hair L.L.C
Organization subpart
No
Provider details
NPI number
Authorized official
BREANNA RICHARDSON (OWNER)
(501) 650-3405
Entity
Organization
Contact information
Practice address
1802 S HIGHWAY 161, JACKSONVILLE, AR 72076-5511
(501) 605-3405
Mailing address
192 WILLIAMSBURG CV, CABOT, AR 72023-9433
(501) 650-3405
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
02/12/2019
Last updated
02/12/2019
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