| NPI | 1801922356 |
|---|---|
| Doing Business As | FOOTHILLS BLVD CLINIC, LLC |
| Entity Type | Organization |
| Authorized Contact | STAMATIA FISSAS GOCKEL Owner/Physician 928-342-1814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2012-02-03 |