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Individual

SAM CLAYTON POTTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
16107 N 165TH LN, SURPRISE, AZ 85388-1141
(623) 337-2511
Mailing address
16107 N 165TH LN, SURPRISE, AZ 85388-1141

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
07/10/2017
Last updated
07/10/2017
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