| NPI | 1609408616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BUCKNER Sole Member 480-930-4018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2020-02-07 |