| NPI | 1679566582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA K FORDYCE Director 928-774-3044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ OSC3471) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2025-07-31 |