| NPI | 1043658115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY WAMBAIRE Program Director 520-248-1919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH4178) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |