| NPI | 1902370349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE MICHAEL ST. JACQUES Owner/Physician 480-783-8964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-01-18 |