| NPI | 1144275025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE L SHERIDAN Office Owner 866-692-0362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 3977) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2008-02-06 |