Organization
VITALITY INTERNAL MEDICINE - GLENDALE LLC
Active
Other names
Mens Vitality Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BENJAMIN EVANS II M.D. (OWNER)
(602) 791-9112
Entity
Organization
Contact information
Practice address
18205 N 51ST AVE STE 129, GLENDALE, AZ 85308-1492
(623) 398-8554
Mailing address
5509 E FRIESS DR, SCOTTSDALE, AZ 85254-2966
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
37616
AZ
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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