| NPI | 1033314547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEE MANNING Director 480-545-7992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: AZ AZ5000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1467) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2020-08-22 |