| NPI | 1437339470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY ANDREW ERTL President/Owner 928-344-0650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: AZ 19732) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2007-11-16 |