| NPI | 1932527348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIFFORD ETIENNE CEO 702-771-0304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NV NV20131689889) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-04-02 |