| NPI | 1053504225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN F HERON Physician Assisitant 928-474-6617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 1454) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |