| NPI | 1689885543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETTA KOSKOVICH Administrator 623-878-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AZ ALC-4673) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |