| NPI | 1023494291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEENA BLAKLEY Sr. Administrative Assistant 623-487-3723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3191) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-08-26 |