| NPI | 1083086631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICE HICKMAN Director Of Community Programming 602-254-7328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 28145) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2017-03-08 |