| NPI | 1083713937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARISE GARDNER Billing & Collections Manager 928-348-1601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ AZ20267) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2357) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-12-14 |