| NPI | 1225528565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMETHYST LAFLEUR Biller/Coder/Credentialing Spec 623-233-1050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty (Licence: AZ 006421) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2022-04-22 |