| NPI | 1679286124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAYEE M SOLO Owner 623-547-9429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2025-02-20 |