| NPI | 1679001168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN A SORENSEN Administrator 602-431-1152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 13583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 13583) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2017-05-26 |