| NPI | 1891727863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN D HAEGER President 928-523-6343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AZ OTC5149) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: AZ 3E115) |
| 261QS1000X Clinic/Center, Student Health | |
| 291U00000X Clinical Medical Laboratory (Licence: AZ 03D0057902) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AZ Y005336) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-08-15 |