| NPI | 1801377270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICE SHANNON HICKMAN Chief Program Officer 602-254-7328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ OTC9085) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2018-08-23 |