| NPI | 1982090338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRBY HOLLIDAY Credentialing Manager 480-857-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ OTC6802) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2015-07-06 |