| NPI | 1154178655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE ESHO Authorized Official 623-249-8930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-15 |