| NPI | 1861633851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY GONZALES Billing/Contracting Manager 928-302-3430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A422040) |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2025-10-23 |