| NPI | 1417112541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRELLE M COPELAND Owner 480-370-2602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 25933) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2020-07-21 |