| NPI | 1154822369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN SHANE MOORE Manager 623-974-0522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2020-02-10 |