| NPI | 1609344969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN VIGNEAU Sole Member 480-290-9899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2018-11-05 |