| NPI | 1811654494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRETT LEATHEM Owner, Authorized Agent 480-573-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2021-11-18 |