| NPI | 1417114166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY GRIM Credentialing Specialist 702-202-4776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2022-03-11 |