| NPI | 1700584414 |
|---|---|
| Doing Business As | IV NUTRITION OF WASH PARK |
| Doing Business As | IV NUTRITION OF WASH PARK, LLC |
| Entity Type | Organization |
| Authorized Contact | EDMOND TERRILL JOHNSON Mr 172-072-7350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2023-02-21 |