| NPI | 1821271255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN K. BRADWAY Owner 480-860-6005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 17615) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2150) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2008-06-17 |