| NPI | 1417582875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BUCKNER Owner 602-421-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2020-03-05 |