03D2139869 CLIA NUMBER - SEDONA WELLNESS RETREAT

Laboratory Demographics

CLIA Number: 03D2139869

Facility Name: SEDONA WELLNESS RETREAT

Facility Address:
125 KALLOF PL
SEDONA, AZ
ZIP 86336
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Facility Phone Number: (928) 239-4589

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1780084236

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2139869
LAB Type	PHYSICIAN OFFICE
Facility Name	SEDONA WELLNESS RETREAT
Street	125 KALLOF PL
City	SEDONA
State	AZ
ZIP	86336
Phone	(928) 239-4589

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This page was last updated on: 5/11/2023