| NPI | 1659732204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELTAHIR ABBO Owner 623-703-2988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SD DL047333) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-03-10 |