Organization
NEW AGE VITALITY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY WIREMAN (OWNER)
(606) 789-8531
Entity
Organization
Contact information
Practice address
327 BROADWAY ST, PAINTSVILLE, KY 41240-1348
(606) 789-8531
(606) 789-8893
Mailing address
327 BROADWAY ST, PAINTSVILLE, KY 41240-1348
(606) 789-8531
(606) 789-8893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/03/2015
Last updated
03/08/2016
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