| 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 |