| NPI | 1033586417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON LEE VAN PELT CEO 775-722-0574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV NV20151498467) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |