Organization
THE ANTI-AGING AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD RAY BONNER D.O. (OWNER)
(601) 421-4808
Entity
Organization
Contact information
Practice address
655 LAKE HARBOUR DR STE 900, RIDGELAND, MS 39157-4355
(601) 707-5171
Mailing address
311 FEATHER GLN, RIDGELAND, MS 39157-8703
(601) 421-4808
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
960070
MS
Other
Enumeration date
12/29/2011
Last updated
12/29/2011
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