| NPI | 1962915892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLA STARR ROBINSON Credentialing Manager 480-804-0326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ OTC-8528) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2017-11-14 |