| NPI | 1952563132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ANTHONY DICARLO President/Owner 928-718-7188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ D6061) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2014-03-06 |