| NPI | 1235760406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MANKIN Administrator 602-510-3203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |