| NPI | 1619606506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RAYBURN Owner 480-553-1547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QC1800X Clinic/Center Corporate Health | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM2500X Clinic/Center Medical Specialty | |
| 261QR1300X Clinic/Center Rural Health | |
| 305S00000X Point of Service | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2022-06-10 |