| NPI | 1083138291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOULANDA YEVETTE JOHNSON Clinical Director 702-853-7092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NV NV20171352430) |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2022-07-21 |