| NPI | 1982836565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE D LUSTER Member 602-548-8733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ LPC 2479) |
| Additional Taxonomies | 251S00000X (Licence: AZ LPC 2478) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2009-08-17 |