| NPI | 1902082464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD CHARLES RUSSO President 480-998-3355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ 2348) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2008-01-15 |