| NPI | 1336477355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKIE PENCE Director 602-881-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 7546NV) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV 965) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |