| NPI | 1992157622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDEN HENLINE Owner And Clinical Director 928-830-8501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: UT 9287734-3902) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2024-05-09 |