NPI | 1023310372 |
---|---|
Doing Business As | FOREVER YOUNG |
Entity Type | Organization |
Authorized Contact | TROY LEE YOUNG Owner,CEO 480-888-0456 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ AL8195H) |
Enumeration Date | 2010-11-18 |
Last Update Date | 2010-11-18 |