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Organization
PWWL CENTERS, LLC
Active
Organization
PWWL CENTERS, LLC
Active
Other names
Physician's Wellness & Weight Loss
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY DALE FREDERIKSEN SR. (MANAGING MEMBER)
(479) 459-6354
Entity
Organization
Contact information
Practice address
644 STATELINE RD, COLCORD, OK 74338-1344
(918) 203-0004
Mailing address
PO BOX 6691, VAN BUREN, AR 72956-0601
(479) 459-6354
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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