Organization
MINT EDITION WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN LONG (DIRECTOR)
(870) 335-6990
Entity
Organization
Contact information
Practice address
1400 N MOUNT JULIET RD STE 104, MOUNT JULIET, TN 37122-1508
(870) 335-6990
Mailing address
1400 N MOUNT JULIET RD STE 104, MOUNT JULIET, TN 37122-1508
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
07/28/2020
Last updated
07/28/2020
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