| NPI | 1164487922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM J. WALDO Administrator 928-537-4240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: AZ OSC0061) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2012-04-19 |