Organization
CHOOSE TO CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERMAINE DAVIS (COO)
(708) 275-9244
Entity
Organization
Contact information
Practice address
15148 W CORTEZ ST, SURPRISE, AZ 85379-5237
(708) 275-9244
Mailing address
15148 W CORTEZ ST, SURPRISE, AZ 85379-5237
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/12/2023
Last updated
05/12/2023
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