| 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 |