| NPI | 1962857383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JO SARGENT Owner 928-856-2208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: AZ #2555) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |