| NPI | 1629220504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN MORTENSON CEO 928-715-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: AZ 08709408) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2008-10-22 |