PROVENANCE HEALTHCARE LLC

LAS VEGAS, NV
NPI1316322738
Entity TypeOrganization
Authorized ContactMARK L BLACK
Owner Operator
702-478-2524
Organization Subpart ?No
Primary Taxonomy170300000X Genetic Counselor, MS
(Licence: NV  other)
Enumeration Date2015-07-27
Last Update Date2015-07-27
Business Address
PROVENANCE HEALTHCARE LLC
5155 S DURANGO DR STE 103
LAS VEGAS, NV 89113-0175
Phone number: 702-478-2524
Mailing Address
PROVENANCE HEALTHCARE LLC
5155 S DURANGO DR STE 103
LAS VEGAS, NV 89113-0175
Phone number: 702-478-2524