| NPI | 1053326751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA MARIE FRAKES CFO 928-607-3994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AZ OTC0677) |
| 261QP2300X Clinic/Center, Primary Care (Licence: OTC0677) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2023-05-26 |