| NPI | 1063785111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA MANN Speech Language Technician 623-691-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |