| NPI | 1316504574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SETH CLARK Owner 623-544-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2024-04-08 |