| NPI | 1174183743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELLE LEVER Director 602-996-0110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-11-15 |