| Organization Name: | AFC OF QUEEN CREEK, PLLC |
| NPI Number: | 1821432501 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | URISSA BOLINE (CREDNETIALING MGR) |
| Mailing Address: | 85 W Combs Rd Ste 109 San Tan Valley |
| State: | AZ US |
| Postal Code: | 851409105 |
| Phone Number: | 4808829105 |
| Fax Number: | 4804585833 |
| NPI Enumeration Date: | 04/24/2013 |
| NPI Last Update Date: | 04/24/2013 |
| 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: | |