| NPI | 1689125171 |
|---|---|
| Other Name | PROVIDENCE ENTERPRISES LLC |
| Entity Type | Organization |
| Authorized Contact | JENNIFER PROVIDENCE Owner 520-332-5509 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: AZ 1046) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |