NPI | 1619410750 |
---|---|
Entity Type | Organization |
Authorized Contact | BRENDON DUANE BAERG Co Owner/Provider 480-575-1142 |
Organization Subpart ? | No |
Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AZ L21375136) |
Enumeration Date | 2016-11-21 |
Last Update Date | 2024-05-10 |