| NPI | 1619739521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE DREVAL Owner 602-400-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-01-25 |