| NPI | 1164704326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANASORN FOWLER Pharmacist 702-648-2732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NV 16568) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |