NPI | 1063615094 |
---|---|
Doing Business As | BODY BLISS WELLNESS CENTER |
Entity Type | Organization |
Authorized Contact | JOHN W. REVELLO Owner 708-364-0638 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 038010310) |
Enumeration Date | 2007-06-07 |
Last Update Date | 2007-08-14 |