| Organization Name: | AFC OF PEORIA, PLLC |
| NPI Number: | 1154668044 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | URISSA FRANCILLE BOLINE (CREDENTIALING COORDINATOR) |
| Mailing Address: | 15256 N 75th Ave Ste 360 Peoria |
| State: | AZ US |
| Postal Code: | 853814761 |
| Phone Number: | 6234862424 |
| Fax Number: | 6324864324 |
| NPI Enumeration Date: | 01/11/2013 |
| NPI Last Update Date: | 01/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |