| NPI | 1164739025 |
|---|---|
| Other Name | RENEW MEDICAL SPA AND NUTRITIONAL WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | THERESA M FONTENOT Owner 903-255-6398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: TX PA00892) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: AR PA-190) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2012-02-06 |