| NPI | 1548465750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES S PETERSON Owner President 480-558-3744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 28027) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2008-12-04 |