| NPI | 1720480940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERCEDES KENISHA WARD Owner 702-994-2611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AZ 302f00000X) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |