| NPI | 1376727610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE SAGE HAGGARD Clinic Director 602-463-7177 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: AZ 04836d) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2007-12-21 |