| NPI | 1578360665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE SANNIEC Manager 602-376-8638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2025-03-03 |