| NPI | 1629439005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA MARIE GILLELAND Manager 623-208-7979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: AZ 34339) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2022-12-27 |