Individual
ANTHONY UDOINWANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10435 W READE AVE, GLENDALE, AZ 85307-4237
(623) 594-0997
(623) 594-0998
Mailing address
PO BOX 14392, PHOENIX, AZ 85063-4392
(602) 757-4861
(623) 594-0998
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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