Organization
RENEW WELLNESS SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA M FONTENOT PA-C (PROVIDER)
(903) 255-6398
Entity
Organization
Contact information
Practice address
3939 TEXAS BLVD, TEXARKANA, TX 75503-3207
(903) 255-6398
(903) 794-6305
Mailing address
3939 TEXAS BLVD, TEXARKANA, TX 75503-3207
(903) 255-6398
(903) 794-6305
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
PA00982
TX
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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