Organization
VENUS HAIR LOSS REPLACEMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AKOSSIWA TATIANE AMENYO CERTIFIED (HAIR LOSS SPECIALIST)
(618) 401-6359
Entity
Organization
Contact information
Practice address
625 S LINCOLN AVE, O FALLON, IL 62269-2663
(618) 401-6359
Mailing address
625 S LINCOLN AVE, O FALLON, IL 62269-2663
(618) 401-6359
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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