| NPI | 1376931493 |
|---|---|
| Doing Business As | CODAC COBBLESTONE COURT |
| Entity Type | Organization |
| Authorized Contact | DENNIS REGNIER CEO 520-327-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: AZ OTC) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AZ OTC) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2015-09-25 |