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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