| NPI | 1730613886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA EASON Owner/Manager 928-221-9632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AZ 5556) |
| Enumeration Date | 2017-04-16 |
| Last Update Date | 2017-04-16 |