Individual
THERESA WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12533 W MONROE ST, AVONDALE, AZ 85323-8006
(623) 849-3773
Mailing address
12533 W MONROE ST, AVONDALE, AZ 85323-8006
(623) 849-3773
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
1537881
AZ
Other
Enumeration date
06/22/2010
Last updated
06/22/2010
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