| NPI | 1033213053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY MARTINEZ Executive Director 928-776-4612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AZ 1033213053) |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2025-05-16 |