| NPI | 1649758590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BUCKNER Owner 480-930-4018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2018-08-02 |