Organization
VITALITY AESTHETICS AND WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY E LAGOS (OPERATIONS MANAGER)
(304) 574-9876
Entity
Organization
Contact information
Practice address
211 W MAPLE AVE, FAYETTEVILLE, WV 25840-1445
(304) 574-9876
Mailing address
PO BOX 329, FAYETTEVILLE, WV 25840-0329
(304) 574-9876
(304) 900-5522
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2313-9790
WV
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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