| NPI | 1447496823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER MARIE THOMESEN Member 702-339-7284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NV 1007222930) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2009-01-06 |