| NPI | 1194906925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA MODESTA Medical Director /President 602-248-8258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: AZ 07569335N) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2007-11-20 |