Organization
ADVANCED WELLNESS GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH RONALD DORITY D.O. (SUPERVISING PHYSICIAN)
(903) 447-5470
Entity
Organization
Contact information
Practice address
2705 E QUINLAN PKWY, QUINLAN, TX 75474-8688
(903) 447-5470
Mailing address
PO BOX 789, QUINLAN, TX 75474-0014
(903) 447-5470
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
Primary
K0722
TX
Other
Enumeration date
12/11/2007
Last updated
10/17/2012
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