Organization
VITAL4MEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD DISHON (MANAGING PARTNER)
(623) 218-1515
Entity
Organization
Contact information
Practice address
7707 W DEER VALLEY RD, 115, PEORIA, AZ 85382-2101
(623) 218-1515
Mailing address
7707 W DEER VALLEY RD, 115, PEORIA, AZ 85382-2101
(623) 218-1515
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
03/07/2012
Last updated
07/10/2012
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