Organization
ARIZONA INDEPENDENT DIAGNOSTIC TESTING FACILITY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF BROUWER (MANAGING MEMBER)
(602) 821-4517
Entity
Organization
Contact information
Practice address
8618 N 35TH AVE STE 3, PHOENIX, AZ 85051-3800
(602) 821-4517
Mailing address
8660 S PEORIA AVE, TULSA, OK 74132-2827
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
12/14/2020
Last updated
12/15/2020
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