| NPI | 1760644595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREI DAMIAN President 602-867-8644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2012-07-23 |