| NPI | 1053775965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY E FLATT Credentialing Manager 702-401-4483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: NV nv20161197177) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2017-09-11 |