| NPI | 1447140504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK GOFORTH Owner 520-904-7987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-08 |