| NPI | 1326224189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND LANCE WALDROP Business Manager 928-376-6650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2008-06-26 |