| NPI | 1770023129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVAWN PERSCHKA Billing Service Representative 602-451-5492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 44077) |
| Enumeration Date | 2017-03-05 |
| Last Update Date | 2017-03-05 |