| NPI | 1629594866 |
|---|---|
| Doing Business As | REVITASPINE |
| Entity Type | Organization |
| Authorized Contact | JONN A MCCLELLAN Owner 561-602-2888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL CH9815) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2018-07-12 |