| NPI | 1932277480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMIAN MICHAEL KIRWAN Clinical Director 602-738-5487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ OTC5939) |
| Additional Taxonomies | 251S00000X (Licence: AZ BH 2842) |
| 251S00000X (Licence: AZ BH-3513) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-04-26 |