| NPI | 1104162288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOFFI SEDDO Administrator Provider 520-891-0081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-4113) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2012-12-18 |