| NPI | 1508207523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT BLACK Owner 928-308-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ CSLG6504) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2015-06-23 |