| NPI | 1134615453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN VIGNEAU Sole Mbr 480-566-9755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ 8494) |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2019-06-07 |