| NPI | 1518081066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATY KELLER Administrative Assistant 480-584-3264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 20274) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: AZ 2834) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2013-05-15 |