| NPI | 1679246532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL G BERAM Program Coordinator 602-254-1995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2021-08-05 |