| NPI | 1710180401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN FREDERIKSEN Practice Administrator 520-615-0318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 31026) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2008-07-21 |