| NPI | 1821708454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL ISAAC LOPEZ CEO 602-488-1172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |