| NPI | 1477983278 |
|---|---|
| Doing Business As | ROANOKE HEALTHY LIFE CENTER- MOHAWK |
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-964-1506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: AL DO436) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2021-05-03 |