| NPI | 1053650499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES B EVANS Medical Director 602-791-9112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AZ 37616) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |