Organization
BOMBSHELL AESTHETICS & WEIGHT LOSS CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA DAWN SPENCE APRN (OWNER/PROVIDER)
(606) 626-7093
Entity
Organization
Contact information
Practice address
197 OTTO DR # 42, INEZ, KY 41224-8808
(606) 229-0072
Mailing address
197 OTTO DR # 42, INEZ, KY 41224-8808
(606) 229-0072
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/10/2024
Last updated
05/10/2024
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