NPI | 1992901672 |
---|---|
Entity Type | Organization |
Authorized Contact | DIANE PITUCH IMMESBERGER Administrative Assistant 928-514-8602 |
Organization Subpart ? | No |
Primary Taxonomy | 174400000X Specialist |
Additional Taxonomies | 305S00000X Point of Service |
Enumeration Date | 2007-06-21 |
Last Update Date | 2018-10-29 |