| NPI | 1194955096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE LINNETTE HARRIS Director 702-491-1265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NV 20000108590101) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2009-07-27 |