Individual
FON EMBOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2841 E TYSON ST, CHANDLER, AZ 85225-4244
(602) 769-4053
Mailing address
2841 E TYSON ST, CHANDLER, AZ 85225-4244
(602) 769-4053
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11983H
AZ
Other
Enumeration date
12/18/2021
Last updated
12/18/2021
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