| NPI | 1316240955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT C BOYD Sole Member/ Manager 928-607-8834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ 302F00000X) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2010-12-20 |