| NPI | 1255667473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY SHAUNTE RICHARDSON Owner 775-342-7437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV 491105) |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2009-10-22 |