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 |