| NPI | 1972022093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL NICHOLAS DESVIGNE Owner 480-471-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 35062) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2017-09-11 |