| NPI | 1053490052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LANG Resource Support Specialist 928-864-7371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ OTC5874) |
| Additional Taxonomies | 251S00000X (Licence: AZ BH316) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-07-14 |