| NPI | 1932477296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY ROSE KELLY Medical Director 702-255-3547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NV 9040) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-01 |