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Organization
REVIVE WELLNESS AND REJUVENATION LLC
Active
Organization
REVIVE WELLNESS AND REJUVENATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GRAHAM DC (PRESIDENT)
(602) 595-7836
Entity
Organization
Contact information
Practice address
20229 N 67TH AVE STE C-A, GLENDALE, AZ 85308-6664
(602) 595-7836
Mailing address
20229 N 67TH AVE STE C-A, GLENDALE, AZ 85308-6664
(602) 595-7836
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/30/2020
Last updated
05/01/2020
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