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NPI #1801586748 in Surprise, Arizona

Provider Information

NPI Number
1801586748
Entity Type
Organization
Organization Name
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Primary Specialty
Clinic/Center
Enumeration Date
May 12, 2023
Last Updated
May 12, 2023

Practice Location

Address
15148 W CORTEZ ST
State
Arizona
ZIP Code
85379-5237
Phone
(708) 275-9244

Authorized Official

Name
JERMAINE DAVIS
Title
COO
Phone
(708) 275-9244

Specialties & Taxonomy Codes

Specialty
Clinic/Center

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