| NPI | 1164799987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTA LYNNE HOWARD Chief Executive Officer 928-442-9205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ CSA03NA0148) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2013-05-16 |