| NPI | 1104359397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JSHAUNTAE MARSHALL President 602-343-1873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: AZ BH5119) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM0801X | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2020-05-28 |