Organization
LIFERESTORE MD USA NC1 LLC
Active
Organization
LIFERESTORE MD USA NC1 LLC
Active
Other names
RestoreDOC MD, liferestore md usa llc
Organization subpart
No
Provider details
NPI number
Authorized official
BOB OLOVSSON (COO)
(214) 494-8121
Entity
Organization
Contact information
Practice address
1427 MILITARY CUTOFF RD STE 140, WILMINGTON, NC 28403-3692
(214) 494-8121
Mailing address
3910 GASTON AVE STE 140, DALLAS, TX 75246-1523
(214) 494-8121
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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