| NPI | 1396066395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH SNOW Medical Director 520-327-0462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NH 7821) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2010-06-14 |