| NPI | 1598009722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY BURL BUSHMAN Owner/Physician 520-384-4291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ 2338) |
| Enumeration Date | 2012-11-10 |
| Last Update Date | 2012-11-10 |