| NPI | 1073955712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CORRAL CEO 520-829-7410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: AZ 03D2063481) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-11-01 |