| NPI | 1164794772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | L PHILIPP WALL Owner 623-544-7266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ 34753) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2014-09-18 |