| NPI | 1720082621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WYATT D WOODARD Owner 928-779-0361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AZ AP1235) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2011-06-08 |