Individual
MISSOURI FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1735 W MISSOURI AVE, #408, PHOENIX, AZ 85015-2605
(602) 643-6577
Mailing address
1735 W MISSOURI AVE, #408, PHOENIX, AZ 85015-2605
(602) 643-6577
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
2477902
AZ
Other
Enumeration date
04/13/2011
Last updated
04/13/2011
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