Revitalife Wellness Center Llc | |
777 S New Ballas Rd Ste 100e Saint Louis MO 63141-8705 | |
(314) 913-5861 | |
Not Available |
Full Name | Revitalife Wellness Center Llc |
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Speciality | Family Medicine |
Location | 777 S New Ballas Rd, Saint Louis, Missouri |
Authorized Official Name and Position | Christina Robins (PRESIDENT) |
Authorized Official Contact | 3149135861 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Revitalife Wellness Center Llc 11402 Oxbridge Ct Saint Louis MO 63146-5491 Ph: (314) 913-5861 | Revitalife Wellness Center Llc 777 S New Ballas Rd Ste 100e Saint Louis MO 63141-8705 Ph: (314) 913-5861 |
NPI Number | 1104185685 |
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Provider Enumeration Date | 05/03/2012 |
Last Update Date | 05/23/2012 |
Identifier | Type | State | Issuer |
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1104185685 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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