| NPI | 1760021802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NETTIE CASTILLO Credentialing Specialist 480-542-4714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2020-01-06 |