Organization
INTEGRATIVE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN LOVEJOY ROQUE M.D. (OWNER)
(980) 223-8535
Entity
Organization
Contact information
Practice address
1703 DAVIE AVE, STATESVILLE, NC 28677-3521
(980) 223-8535
(980) 223-8585
Mailing address
1703 DAVIE AVE, STATESVILLE, NC 28677-3521
(980) 223-8535
(980) 223-8585
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
9500440
NC
363LF0000X
Family Nurse Practitioner
161312
NC
Other
Enumeration date
06/10/2014
Last updated
07/16/2014
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