| NPI | 1497349799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK VANDEVER Owner 623-566-3436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-06-14 |