| NPI | 1134257769 |
|---|---|
| Other Name | ISP 4TH AVENUE |
| Entity Type | Organization |
| Authorized Contact | ANNETTE INIGUEZ Executive Assistant 602-285-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |