| NPI | 1659787497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL FERGUSON Provider 480-830-1553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2019-11-01 |