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 |