| NPI | 1013312925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANN DAVIS Office Manager 480-821-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 26816) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2019-10-29 |