Revitalife Wellness Center Llc

NPI 1104185685 - Family Medicine - 207Q00000X

NPI Details
NPI 1104185685
Enumeration Date 05/03/2012
Last Updated 05/23/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name CHRISTINA CHRISTINA
Position PRESIDENT
Phone (314) 913-5861
Fax
Practice Location
777 S NEW BALLAS RD
STE 100E
SAINT LOUIS MO, 63141-8705, US
Phone (314) 913-5861
Fax
Business Location
11402 OXBRIDGE CT
SAINT LOUIS MO, 63146-5491, US
Phone (314) 913-5861
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State
License Number
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According to our database, Revitalife Wellness Center Llc NPI is 1104185685, taxonomy code is 207Q00000X Revitalife Wellness Center Llc physically located at 777 S New Ballas Rd, Saint Louis MO, 63141-8705. NPI Number 1033115704 has the healthcare provider type.

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1104185685 NPI number is provided on an as is basis without warranty of any kind. 1104185685 is maintained by the National Plan & Provider Enumeration System. The contents of Revitalife Wellness Center Llc are for informational purposes only.