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Organization

LIFETIME WOMEN'S HEALTH & FITNESS CENTERS P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EDWARD ELLISON WING MD (PRESIDENT)
(757) 395-7414
Entity
Organization

Contact information

Practice address
1037 CHAMPIONS WAY, SUITE 300, SUFFOLK, VA 23435-3764
(757) 395-7414
(757) 923-4607
Mailing address
3575 BRIDGE RD, SUITE 8 PMB 433, SUFFOLK, VA 23435-1800
(757) 395-7414
(757) 923-4607

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101240033
VA

Other

Enumeration date
10/24/2012
Last updated
10/24/2012
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