Organization
MIXED ROOTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA MCCRAY STYLIST (SALON OWNER)
(856) 236-6555
Entity
Organization
Contact information
Practice address
6300 CREEDMOOR RD STE 118, RALEIGH, NC 27612-6730
(919) 720-4080
Mailing address
10624 SUNNY POINT DR, ZEBULON, NC 27597-6880
(856) 236-6555
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/18/2024
Last updated
01/18/2024
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