| NPI | 1114337565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESUS DANIEL SULLIVAN CEO 928-446-7146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM LISAC-10172) |
| Additional Taxonomies | 251S00000X (Licence: AZ DVS0017) |
| 251S00000X (Licence: AZ DUI0024) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2014-05-06 |