| NPI | 1033319751 |
|---|---|
| Other Name | CODAC 4TH AVENUE |
| Entity Type | Organization |
| Authorized Contact | W MARK CLARK CEO 520-327-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2008-02-15 |