| NPI | 1467801134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FESTUS EBONKA President 702-515-9680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-11-15 |