| NPI | 1750925517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORINE HAYNES Owner 702-412-9077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2021-08-31 |