| NPI | 1831446749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A TERRY Owner 623-512-4326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 005223) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 005223) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2014-09-04 |