| NPI | 1366597718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA A DAVIS Owner 928-634-5118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X (Licence: AZ 4555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4555) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2025-09-11 |