| NPI | 1538314562 |
|---|---|
| Doing Business As | LONGEVITY WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | GREGORY TRENT DAVIS CEO 512-323-9222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: TX DC30474) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2013-04-15 |