Organization
RESTORATIV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL VANCE RN (DIRECTOR)
(769) 300-0730
Entity
Organization
Contact information
Practice address
129 FOUNTAINS BLVD STE 101, MADISON, MS 39110-6361
(769) 300-0730
(601) 949-2782
Mailing address
129 FOUNTAINS BLVD STE 101, MADISON, MS 39110-6361
(769) 300-0730
(601) 949-2782
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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