| NPI | 1861261943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANYE CARSON Owner 602-579-1711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-12-29 |
| Last Update Date | 2024-01-23 |