| NPI | 1679730493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L LARUE Billing 928-333-5333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AZ 32794) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-27 |