| Name | KELLY VAN WAGNER |
|---|---|
| Address | 2225 VILLAGE WALK STE 27D |
| City | HENDERSON |
| State | NV |
| Zip | 89052 |
| Mailing State | NV |
| Agent Type | Noncommercial Registered Agent |
| Company | VAN WAGNER HEALTHCARE MANAGEMENT, LLC |
|---|---|
| Entity Number | E0323672008-1 |
| NV Business ID | NV20081449696 |