| NPI | 1154740348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M. PACE Medical Director 602-296-4060 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: AZ AP5397) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |