| NPI | 1396919387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD BOLIN Executive Director 928-771-5758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AZ 35216) |
| Additional Taxonomies | 261QP2400X Clinic/Center, Prison Health (Licence: AZ 35216) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2010-10-05 |