Individual
CORBY PLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1201 S 7TH AVE, PHOENIX, AZ 85007-3913
(602) 416-7600
Mailing address
1621 ANTIOCH CHURCH RD, ALVATON, KY 42122-9606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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