| NPI | 1659108256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID SELMAN CEO/CFO 602-654-3294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-12-13 |