Organization
DIETITIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON RUSSO (OWNER MANAGER)
(704) 277-9059
Entity
Organization
Contact information
Practice address
1315 MATTHEWS MINT HILL RD STE B, MATTHEWS, NC 28105-2694
(704) 277-9059
Mailing address
12113 LANDEN DR, CHARLOTTE, NC 28277-4664
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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