| NPI | 1366052870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE MASON Administrator 623-229-4755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2024-06-28 |