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1992588750
REVIVED VITALITY
MYRTLE BEACH, SC
NPI
1992588750
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Entity Type
Organization
Authorized Contact
JENNINGS MICHAEL PERRY
Owner/Provider
843-855-2299
Organization Subpart ?
No
Primary Taxonomy
261Q00000X Clinic/Center
Enumeration Date
2023-08-16
Last Update Date
2023-08-16
Business Address
REVIVED VITALITY
1301 48TH AVE N # A-2
MYRTLE BEACH, SC 29577-5427
Phone number: 843-580-3694
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Mailing Address
REVIVED VITALITY
606 BALD EAGLE DR STE 201
MARCO ISLAND, FL 34145-2731
Phone number: 843-855-2299
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