| NPI | 1194277426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE HIRAM ALVAREZ Owner/Provider 928-758-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: AZ 21702) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-12-29 |