Organization
ICE HEALTH SERVICE CORPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT STEPHEN (HEALTH SERVICE ADMINISTRATOR)
(520) 868-8439
Entity
Organization
Contact information
Practice address
3250 N PINAL PKWY, FLORENCE, AZ 85132-9459
(520) 868-2049
(520) 868-1547
Mailing address
3250 N PINAL PKWY, FLORENCE, AZ 85132-9459
(520) 868-2049
(520) 868-1547
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
0024169459
VA
Other
Enumeration date
04/28/2013
Last updated
04/28/2013
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