| NPI | 1245795459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN S. GILLIAM Medical Director 928-772-1673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2020-06-30 |