| NPI | 1710528047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL BENSON Billing/Credentialing Manager 702-600-7977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2020-06-06 |