| NPI | 1730504796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY JASON BUCK Owner 480-269-1733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: AZ LPC-13746) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2015-09-04 |