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Organization

FOUR CORNERS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. OSAMA WALI (GENERAL MANAGER)
(520) 339-9726
Entity
Organization

Contact information

Practice address
1704 LLANO ST STE B, SANTA FE, NM 87505-5415
(520) 339-9276
Mailing address
5761 W PARK AVE, CHANDLER, AZ 85226-1241
(520) 339-9726

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5696496
NM
Enumeration date
07/12/2018
Last updated
07/12/2018
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