| NPI | 1467147249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN J WOODSIDE Owner 928-536-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2025-01-07 |