| NPI | 1265745103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HANEY Business Manager 520-421-0986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ OTC4997) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2020-01-17 |