| NPI | 1124208269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBA CALDERON Credentialing Specialist 520-318-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 20041) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2022-03-02 |