| NPI | 1679826051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERI L RICHARDSON Member 480-586-0554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2908) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2024-03-07 |