| NPI | 1063433720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROGERS Executive Director 928-819-8999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 208D00000X General Practice | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-04-05 |