Organization
THE SPA 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DALE GRISE LMT, LE (MGR)
(270) 886-7721
Entity
Organization
Contact information
Practice address
929 SKYLINE DR, HOPKINSVILLE, KY 42240-5098
(270) 886-7721
Mailing address
929 SKYLINE DR, HOPKINSVILLE, KY 42240-5098
(270) 886-7721
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
KY0196
KY
Other
Enumeration date
02/22/2007
Last updated
08/22/2020
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