Organization
INTEGRATED WELLNESS CLUB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSTOM ALI PHD (MEMBER, LLC)
(480) 703-4227
Entity
Organization
Contact information
Practice address
1968 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5729
(480) 703-4227
Mailing address
1968 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5729
(480) 703-4227
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
08/16/2014
Last updated
08/16/2014
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