| NPI | 1447644711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN LEE WAYCHOFF Owner 602-284-8994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: AZ AP2129) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: AZ 37050) |
| 305S00000X Point of Service (Licence: AZ AP2433) | |
| 305S00000X Point of Service (Licence: 42847) | |
| 305S00000X Point of Service (Licence: AZ 40062) | |
| 305S00000X Point of Service (Licence: AZ AP3569) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2015-04-01 |