| NPI | 1942870365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAIMOUNA R CANTRALL Owner 702-589-0701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2021-06-28 |