| NPI | 1699353870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WAYNE HERTZBERG Reverend /Owner 480-290-6071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2021-03-30 |