NPI | 1669860904 |
---|---|
Entity Type | Organization |
Authorized Contact | JESS HAYMORE Owner 520-297-2514 |
Organization Subpart ? | Yes |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ AZ5698) |
Enumeration Date | 2015-01-08 |
Last Update Date | 2015-01-08 |