Organization
ILIVEWELL NUTRITION THERPAY, LLC
Active
Parent organization
PRACTICE FUSION
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRACTICE FUSION
Authorized official
ADRIEN PACZOSA (PRESIDENT)
(512) 547-9274
Entity
Organization
Contact information
Practice address
801 RANCH ROAD 620 S, LAKEWAY, TX 78734-5316
(512) 547-9274
Mailing address
801 RANCH ROAD 620 S, LAKEWAY, TX 78734-5316
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
DT82817
TX
Other
Enumeration date
10/05/2013
Last updated
10/05/2013
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