| NPI | 1104246446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC BOON Officer/AO 480-567-0269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: HI FSOF-13) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2024-11-10 |