| NPI | 1982724480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA W HALE Medicaid Coordinator 602-304-3117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 554841) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-08-22 |