| NPI | 1720744949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY WILLIAMS Owner 702-273-6142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2022-01-11 |