| NPI | 1205530441 |
|---|---|
| Doing Business As | MEDICAL |
| Entity Type | Organization |
| Authorized Contact | WAYNE C MCLEOD Manager 520-906-1940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |