| NPI | 1144755182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER HANSEN CEO 928-645-9675 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: AZ OTC7466) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-09-23 |