| NPI | 1053784090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN HUNSAKER Owner 480-895-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 6166) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: AZ 5860) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |