| NPI | 1659713451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN PENNEPACKER President 702-588-4532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV 7599PCS-0) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2019-08-06 |