| NPI | 1376998666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FADI DEEB Owner 520-795-3090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ 0000000) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2020-02-18 |