| NPI | 1194988824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE R DUVAL Credentialing 928-226-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ 30420) |
| Additional Taxonomies | 261QR0404X Clinic/Center, Rehabilitation, Cardiac Facilities (Licence: AZ 30420) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2009-04-07 |