| NPI | 1982917175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DD SANDE Credentialing Specialist 520-682-4560 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: AZ OTC4723) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2010-10-08 |