| NPI | 1790387694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW COEN Director 602-762-1128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QR0400X Clinic/Center Rehabilitation |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2020-11-15 |