| NPI | 1295211340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVONNA ANNE JOHNSON Provider/Administrator 520-488-1756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2023-11-15 |