| NPI | 1174062673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MCCRACKEN Owner/Medical Provider 480-905-8485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 6627) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2019-11-07 |