| NPI | 1457576068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM EVANS Office Manager 520-647-8854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3202) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2249) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |