| NPI | 1861852972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW GLEASON Authorized Official 520-547-4115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QL0400X Clinic/Center, Lithotripsy |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2018-09-10 |