| NPI | 1992476543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KNOBLAUCH Owner 602-625-7944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-12-20 |