| NPI | 1750712766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RAZO Contracts Director 602-258-6797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: AZ OTC-5327) |
| 261QH0100X Clinic/Center, Health Services (Licence: AZ BH-3165) | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2021-11-02 |