| NPI | 1043652910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CHURCH Owner 480-206-0139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 7892) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |