| NPI | 1205135969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BASS Practice Manager 602-717-4751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC0050X Clinic/Center, Critical Access Hospital |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2011-03-21 |