| NPI | 1134280738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISSY LEWIS Billing Manger 928-774-3318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 15978) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2012-10-10 |