| NPI | 1659766137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFORTRA DIANE TURNER Manager Agent 702-489-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV nv20141299285) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2015-04-01 |