| NPI | 1730391699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA ANN COOKE President 928-556-9222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: AZ 80286842) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |