| NPI | 1730744228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MANKIN Administrator 602-510-3203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-05-09 |