| NPI | 1912712506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY KARANIUK C Redentialing 480-242-9268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-02-11 |