| NPI | 1962673574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUMINITA IACOB Owner And Manager 623-326-5464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AZ L13738154) |
| Enumeration Date | 2008-03-23 |
| Last Update Date | 2008-03-23 |