| NPI | 1962589879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTA LYNNE HOWARD CEO 928-442-9205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ CSA03NA0148) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-06-07 |