| NPI | 1760918254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARITY ELIZABETH NORTHAN Owner 602-529-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-09-01 |