Organization
MY VIVE HEALTH AND FITNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT OLIVER (AUTHORIZED OFFICIAL)
(570) 371-3572
Entity
Organization
Contact information
Practice address
500 3RD AVE, KINGSTON, PA 18704-5810
(570) 371-3572
Mailing address
500 3RD AVE, KINGSTON, PA 18704-5810
(570) 371-3572
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/13/2020
Last updated
07/02/2021
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