| NPI | 1952753410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KENYON Credentialing And Billing Manager 775-221-3281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NV PY0736) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2016-07-09 |