| NPI | 1902446495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BUCKNER Sole Member 602-421-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2020-01-13 |