Organization
LEGACY LACE WIGS LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SANFORD (COO)
(972) 914-9447
Entity
Organization
Contact information
Practice address
2605 SAGEBRUSH DR, SUITE 105, FLOWER MOUND, TX 75028-2761
(972) 914-9447
Mailing address
2201 LONG PRAIRIE RD, 107-824, FLOWER MOUND, TX 75022-4832
(972) 914-9447
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
07/10/2014
Last updated
07/31/2015
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