| NPI | 1548338056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRAH CAROLYN CLARK Administrator 520-682-7886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ BH2126) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-08-22 |