| NPI | 1659038529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON ANDERSON Owner 702-268-6218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2022-01-11 |