| NPI | 1528013364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY TRENT FULLMER Owner 480-216-2231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ P-1257205-6) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-03-27 |