| NPI | 1598944811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JO VITA URSO Owner 928-680-2846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AZ 3696) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA 20A8265) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2012-02-29 |