| NPI | 1447525134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE BLAIR NIELSEN Owner 602-803-5032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AZ 4564) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2012-03-14 |