| NPI | 1780900910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE M WEIDNER Administrative Assistant 928-263-9657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4035) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2010-07-29 |