Individual
MS. PAULA IRENE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COSMET HAIR REPLACEM
Contact information
Practice address
407 SPRUCE LN, BECKLEY, WV 25801-2573
(304) 237-6904
Mailing address
407 SPRUCE LN, BECKLEY, WV 25801-2573
(304) 237-6904
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
030306
WV
Other
Enumeration date
03/12/2009
Last updated
03/12/2009
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