| NPI | 1083681100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN A WALLACE Authorized Signer 928-343-2180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-12-06 |