| NPI | 1013349570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIA DANIS Credentialing Specialist 520-591-5394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AZ OTC6465) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2024-07-31 |