| NPI | 1275704280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE RAY Owner 928-778-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ RN113606) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |