| NPI | 1881945517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL E BRIDGES Owner 602-867-1797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AZ 2002) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2013-01-22 |