Organization
FOUNTAIN LIFE DALLAS, LLC
Active
Organization
FOUNTAIN LIFE DALLAS, LLC
Active
Other names
Fountain Life Orlando, LLLC
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA WOO (DIRECTOR OF CLINICAL OPERATIONS)
(917) 810-8672
Entity
Organization
Contact information
Practice address
5762 GRANDSCAPE BLVD STE 115, THE COLONY, TX 75056-6782
(469) 669-0336
Mailing address
5762 GRANDSCAPE BLVD STE 115, THE COLONY, TX 75056-6782
(469) 669-0336
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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