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Organization

OLIVES ESCAPE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TOLESIA DAVIS (BILLING MANAGER)
(903) 742-9416
Entity
Organization

Contact information

Practice address
414 E LOOP 281 STE 16&17, LONGVIEW, TX 75605-7930
(903) 445-2942
Mailing address
414 E LOOP 281 STE 16&17, LONGVIEW, TX 75605-7930
(903) 445-2942

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Enumeration date
04/14/2021
Last updated
04/14/2021
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