| NPI | 1932620390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTELLA HERNANDEZ Contracts & Credentialing Admin 520-838-5513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ BH4382) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2022-06-10 |