CCENT & FPS

LAKESIDE, AR
NPI1467629469
Entity TypeOrganization
Authorized ContactTAMARAH A FRATIANNI
Physician
928-774-1873
Organization Subpart ?Yes
Primary Taxonomy207K00000X Allergy & Immunology
(Licence: AZ  3000)
Additional Taxonomies207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery
(Licence: AZ  3000)
Enumeration Date2008-05-09
Last Update Date2008-05-09
Business Address
CCENT & FPS
300 W WHITE MOUNTAIN BLVD SUITE D
LAKESIDE, AR 85929-6533
Phone number: 928-774-1873
Mailing Address
CCENT & FPS
1340 N RIM DRIVE
FLAGSTAFF, AZ 86001-1311
Phone number: 928-774-1873