Grapevine Clinic LLC

NPI #1164731030 in Fort Mohave, Arizona

Provider Information

NPI Number: 1164731030
Entity Type: Organization
Organization Name: Grapevine Clinic LLC
Primary Specialty: Family Medicine
Enumeration Date: Sep 27, 2010
Last Updated: Sep 27, 2010

Practice Location

Address: 5300 S HIGHWAY 95
Address 2: SUITE H
City: Fort Mohave
State: Arizona
ZIP Code: 86426-9251
Phone: (928) 788-6060

Authorized Official

Name: KAYE A CUNNINGHAM, MD
Title: OWNER/MEMBER
Phone: (928) 788-6060

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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