Individual
CAROL VALLECALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12119 E. METZ DR, VAIL, AZ 85641
(562) 381-5502
Mailing address
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC, 994 S HARRISON RD, TUCSON, AZ 85748
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
4729270
AZ
Other
Enumeration date
12/09/2014
Last updated
11/13/2019
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