| NPI | 1922566694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN FRED MACDOUGALL Business Owner 602-788-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2019-03-12 |