| NPI | 1154796969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUMAN THOMPSON Manager 928-704-4499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2023-11-22 |