| NPI | 1851762769 |
|---|---|
| Doing Business As | HEALTH SOURCE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | RAYMOND DI IULIO Managing Member 754-264-7540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: ME53109) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2016-02-22 |