| NPI | 1801139712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEPRA L JACK Director Of Operations 480-999-7911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2013-03-29 |