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AMN Healthcare Announces Fourth Quarter and Full Year 2023 Results

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AMN Healthcare Services, Inc. reported quarterly revenue of $818 million, with GAAP EPS of $0.33 and adjusted EPS of $1.32. The company faced a challenging year in 2023 but focused on innovation and technology solutions, leading to transformative growth. Despite revenue declines, key highlights include significant tech advancements, a large MSP client win, and recognition for workplace diversity. Financially, the company saw a decrease in net income and diluted EPS, attributed to lower revenue across segments. The acquisition of MSDR boosted locum tenens revenue, while SG&A expenses decreased year-over-year. The company's outlook for 2024 anticipates lower revenue across segments but higher revenue in Physician and Leadership Solutions. Cash flow remained strong, with total debt of $1.31 billion and a net leverage ratio of 2.2 to 1.
Positive
  • Significant tech advancements and a large MSP client win in Q4 2023.
  • Recognition for workplace diversity by Newsweek.
  • Decrease in net income and diluted EPS due to lower revenue.
  • Acquisition of MSDR boosted locum tenens revenue.
  • SG&A expenses decreased year-over-year.
  • Outlook for 2024 anticipates lower revenue but higher revenue in Physician and Leadership Solutions.
  • Strong cash flow with total debt of $1.31 billion and a net leverage ratio of 2.2 to 1.
Negative
  • Significant revenue declines in Q4 and full year 2023.
  • Decrease in gross margin primarily driven by lower margin in Nurse and Allied Solutions.
  • Year-over-year decrease in adjusted EBITDA and adjusted EBITDA margin.
  • Cash flow from operations was a use of $41 million for the quarter.
  • Consolidated revenue in Q1 2024 projected to be 26-28% lower than the year-ago period.

The reported quarterly revenue decline of 27% and the full year revenue dip of 28% at AMN Healthcare Services indicate a significant contraction in the company's business operations, particularly within the Nurse and Allied Solutions segment. The gross profit margin contraction and the substantial 85% decrease in net income year over year reflect intense margin pressures and possibly increased operational costs or decreased demand for staffing services.

From a financial perspective, the adjusted EBITDA margin decline is also notable as it suggests that the company's earnings, before interest, taxes, depreciation and amortization, have become less profitable. This could be indicative of a challenging operating environment or inefficiencies that have yet to be addressed. Investors and stakeholders should consider these factors when assessing the company's financial health and future profitability.

Moreover, the acquisition of MSDR and the investment in technology and branding under the One AMN initiative represent strategic moves to diversify and strengthen the company's service offerings. However, the financial benefits of these initiatives will need to be closely monitored to ensure they contribute positively to the bottom line in the long-term.

AMN's reported results reflect a broader trend in the healthcare staffing industry, which is experiencing a cyclical reset in staffing demand. This reset has likely been influenced by the normalization of healthcare services post-pandemic and the adjustment of temporary staffing levels. The company's focus on technology and innovation, specifically through the development of mobile apps and AI-empowered self-service platforms, is a strategic response to the evolving needs of the healthcare industry.

It is also worth noting the positive growth in language services, which contrasts with the overall decline in other segments. This suggests that there are niche areas within the company's portfolio that are expanding, potentially offering avenues for growth amidst broader market challenges. The company's branding and platform consolidation efforts under the One AMN initiative could streamline operations and improve client engagement, but the impact of these changes on sales and revenue growth will require further analysis over subsequent quarters.

The financial results of AMN Healthcare Services reflect underlying economic factors affecting the healthcare staffing industry. The decrease in demand for travel nurses, as indicated by the 40% year-over-year revenue decline in that segment, could be a result of budgetary constraints within healthcare institutions or a shift towards permanent hiring practices. The increase in locum tenens business suggests a continued reliance on temporary physician staffing, which may be due to ongoing shortages in certain medical specialties.

Additionally, the company's capital expenditures of over $100 million indicate a significant investment in growth opportunities, which could either position the company favorably for future market demands or strain financial resources if not managed effectively. The net leverage ratio of 2.2 to 1 is an important metric indicating the company's debt level in relation to its EBITDA and stakeholders should monitor this in relation to industry norms and the company's ability to service its debt.

Quarterly revenue of $818 million;
GAAP EPS of $0.33 and adjusted EPS of $1.32

DALLAS, Feb. 15, 2024 (GLOBE NEWSWIRE) -- AMN Healthcare Services, Inc. (NYSE: AMN), the leader and innovator in total talent solutions for healthcare organizations across the United States, today announced its fourth quarter and full year 2023 financial results. Financial highlights are as follows:

Dollars in millions, except per share amounts.

 Q4 2023% Change
Q4 2022
Full Year
2023
% Change
Full Year
2022
Revenue$818.3(27%)$3,789.3(28%)
Gross profit$260.9(30%)$1,249.6(27%)
Net income$12.5(85%)$210.7(53%)
Diluted EPS$0.33(83%)$5.36(46%)
Adjusted diluted EPS*$1.32(47%)$8.21(31%)
Adjusted EBITDA*$104.0(40%)$579.1(32%)
* See “Non-GAAP Measures” below for a discussion of our use of non-GAAP items and the table entitled “Non-GAAP Reconciliation Tables” for a reconciliation of non-GAAP items.
 

2023 & Recent Highlights

  • AMN worked through the largest cyclical reset in industry history in 2023 while also accelerating innovation and building a stronger position in technology-enabled total talent solutions.
  • We achieved our most transformative year for our technology, both in platforms that support corporate operations and those dedicated to our clients and healthcare professionals.
  • In Q4, we continued the tech momentum with Market Insights and Analytics for ShiftWise Flex vendor management, powered by our robust dataset, plus the first mobile apps for ShiftWise Flex and Smart Square scheduling, and AI-empowered self-service in AMN Passport for healthcare professionals.
  • Our One AMN branding and an integrated go-to-market platform and experience are adding momentum to our sales pipeline while also bringing candidate traffic and applicants that exceeded our expectations. In the quarter, we signed our largest MSP client win since 2019.
  • Q4 2023 financial results were consistent with our expectations, with strength in language services and our organic locum tenens business.
  • Our MSDR acquisition brings our annualized revenue run rate in locum tenens to more than $600 million.
  • AMN was named one of America's Greatest Workplaces for Diversity by Newsweek, recognizing our commitment to inclusion and our values-based culture.

"Our healthcare professionals and corporate team members were resilient in 2023, working through the largest cyclical reset of staffing demand in industry history," said Cary Grace, AMN President and Chief Executive Officer. "While partnering with clients to help them rebuild sustainable workforces, our team simultaneously accelerated innovation, enabling AMN to enter this year better positioned to deliver the technology-centric total talent solutions that healthcare needs now.

"We invested heavily in our growth opportunities with more than $100 million of capex while rigorously managing financial discipline in operations," Ms. Grace added. "We are consolidating our businesses under our One AMN branding and platform initiative and building a unified, client-centric sales and service organization. Our service lines are infused with new technology that speeds our operations, better integrates us with clients, and delivers powerful mobile tools that give clients and healthcare professionals more control and flexibility. Further, we strengthened our capabilities in locum tenens with the acquisition of MSDR. These accomplishments were enabled by our strong cash flow, the talent and passion of our team members, the uniquely strong AMN culture, and a commitment to performing for our stakeholders."

Fourth Quarter 2023 Results

Consolidated revenue for the quarter was $818 million, a 27% decrease over prior year and 4% lower than prior quarter. Net income was $12 million (1.5% of revenue), or $0.33 per diluted share, compared with $82 million (7.3% of revenue), or $1.88 per diluted share, in the same quarter last year. Adjusted diluted EPS was $1.32 compared with $2.48 in the year-ago quarter.

Revenue for the Nurse and Allied Solutions segment was $538 million, lower by 35% year over year and down 6% sequentially. Travel Nurse revenue was down 40% year over year and 8% sequentially. Allied division revenue declined 16% year over year and 2% versus prior quarter.

The Physician and Leadership Solutions segment reported revenue of $168 million, flat year over year and up 5% sequentially. Organic locum tenens revenue grew 7% year over year and was down 2% versus the prior quarter. Interim leadership revenue was down 35% year over year and 5% sequentially. Search revenue was lower by 20% year over year and 6% quarter over quarter. The MSDR acquisition closed in late November and contributed revenue of $13 million for the quarter.

Technology and Workforce Solutions segment revenue was $113 million reflecting a decrease of 16% year over year and 7% sequentially. Language services revenue was $68 million in the quarter, up 18% year over year and 3% compared with the prior quarter. Vendor management systems revenue was $31 million, 45% lower year over year and down 20% sequentially.

Consolidated gross margin was 31.9%, lower by 140 basis points year over year and lower by 200 basis points sequentially. The year-over-year decline in gross margin was primarily driven by lower margin in Nurse and Allied Solutions and lower VMS revenue. On a sequential basis, gross margin decreased due to the same factors and benefits in the third quarter gross margin that did not recur in the fourth quarter.

SG&A expenses were $185 million or 22.7% of revenue, compared with $219 million, or 19.5% of revenue, in the same quarter last year. SG&A was $163 million, or 19.1% of revenue, in the previous quarter. The year-over-year decrease in SG&A costs was primarily due to lower employee expenses given lower revenue. The quarter-over-quarter increase was driven primarily by increased acquisition, integration and other costs, including MSDR acquisition costs, and the absence of favorable items included in the third quarter results.

Income from operations was $34 million, or 4.2% of revenue, compared with $119 million, or 10.6% of revenue, in the same quarter last year. Adjusted EBITDA was $104 million, with a year-over-year decrease of 40%. Adjusted EBITDA margin was 12.7%, lower by 280 basis points year over year and a decrease of 300 basis points sequentially.

Full Year 2023 Results

Full year 2023 consolidated revenue was $3.789 billion, a 28% decrease from prior year. Full year net income was $211 million (5.6% of revenue), or $5.36 per diluted share, compared with $444 million (8.5% of revenue), or $9.90 per diluted share, in the prior year. Adjusted diluted EPS was $8.21 compared with $11.90 in 2022.

Nurse and Allied Solutions segment revenue was $2.625 billion, a year-over-year decrease of 34%. The Physician and Leadership Solutions segment recorded revenue of $670 million, 4% lower compared with the prior year. Technology and Workforce Solutions segment revenue was $495 million, 12% lower year over year.

Full year consolidated gross margin was 33.0% compared with 32.7% for the prior year. The slight increase in gross margin year over year is primarily attributable to a favorable revenue mix shift and higher margin in Nurse and Allied Solutions, partially offset by lower margin in Technology and Workforce Solutions.

Full year consolidated SG&A expenses were $756 million, representing 20.0% of revenue as compared to $937 million, representing 17.9% of revenue, for the prior year. The year-over-year decrease in SG&A expenses was primarily due to lower employee compensation and benefits.

Full year income from operations was $338 million, or 8.9% of revenue, compared with $647 million, or 12.3% of revenue, in the prior year. Adjusted EBITDA was $579 million, a year-over-year decrease of 32%. Adjusted EBITDA margin was 15.3%, 80 basis points lower year over year.

At December 31, 2023, cash and cash equivalents totaled $33 million. Cash flow from operations was a use of $41 million for the quarter. Cash flow from operations for the full year was $372 million. Capital expenditures were $30 million in the quarter and $104 million for the year. The Company ended the year with total debt outstanding of $1,310 million and a net leverage ratio of 2.2 to 1.

First Quarter 2024 Outlook

 Metric
Guidance* 
 Consolidated revenue$810 - $830 million 
 Gross margin31.0% - 31.5% 
 
 SG&A as percentage of revenue
21.0% - 21.5% 
 Operating margin
4.2% - 4.9%
 
 Adjusted EBITDA margin11.2% - 11.7% 
 *Note: Guidance percentage metrics are approximate.  For a reconciliation of adjusted EBITDA margin, see the table entitled “Reconciliation of Guidance Operating Margin to Guidance Adjusted EBITDA Margin” below. 
   

Consolidated revenue in the first quarter of 2024 is projected to be 26-28% lower than the year-ago period. Nurse and Allied Solutions segment revenue is expected to be down 36-38% below prior year. We expect Physician and Leadership Solutions segment revenue in the first quarter to be 11-14% higher year over year. Technology and Workforce Solutions segment revenue is projected to be down 18-20% year over year.

Other first quarter estimates include depreciation expense of $17 million, depreciation in cost of services of $2 million, non-cash amortization expense of $25 million, stock-based compensation expense of $7 million, interest expense of $16 million, integration and other expenses of $6 million, an adjusted tax rate of 30%, and 38.2 million weighted average diluted shares.

Conference Call on February 15, 2024

AMN Healthcare Services, Inc. (NYSE: AMN), the leader and innovator in total talent solutions for healthcare, will host a conference call to discuss its fourth quarter and full year 2023 financial results and first quarter 2024 outlook on Thursday, February 15, 2024, at 5:00 p.m. Eastern Time. A live webcast of the call can be accessed through this webcast link, which also will be available at AMN Healthcare’s investor relations website. Interested parties may participate live via telephone by registering at this conference call link. Please follow the link and register with a valid e-mail address. A PIN will be provided to you with dial-in instructions. If you lose track of these details, please re-register at the conference call link above.

About AMN Healthcare

AMN Healthcare is the leader and innovator in total talent solutions for healthcare organizations across the United States. The Company provides access to the most comprehensive network of quality healthcare professionals through its innovative recruitment strategies and breadth of career opportunities. With insights and expertise, AMN Healthcare helps providers optimize their workforce to successfully reduce complexity, increase efficiency and improve patient outcomes. AMN total talent solutions include managed services programs, clinical and interim healthcare leaders, temporary staffing, direct higher and retained search solutions, vendor management systems, recruitment process outsourcing, predictive modeling, language interpretation services, revenue cycle solutions, credentialing, and other services. Clients include acute-care hospitals, community health centers and clinics, physician practice groups, retail and urgent care centers, home health facilities, schools, and many other healthcare settings. AMN Healthcare is committed to fostering and maintaining a diverse team that reflects the communities we serve. Our commitment to the inclusion of many different backgrounds, experiences and perspectives enables our innovation and leadership in the healthcare services industry.
The Company’s common stock is listed on the New York Stock Exchange under the symbol “AMN.” For more information about AMN Healthcare, visit www.amnhealthcare.com, where the Company posts news releases, investor presentations, webcasts, SEC filings and other material information. The Company also utilizes email alerts and Really Simple Syndication (“RSS”) as routine channels to supplement distribution of this information. To register for email alerts and RSS, visit http://ir.amnhealthcare.com.

Non-GAAP Measures

This earnings release and the non-GAAP reconciliation tables included with the earnings release contain certain non-GAAP financial information, which the Company provides as additional information, and not as an alternative, to the Company’s condensed consolidated financial statements presented in accordance with GAAP. These non-GAAP financial measures include (1) adjusted EBITDA, (2) adjusted EBITDA margin, (3) adjusted net income, and (4) adjusted diluted EPS. The Company provides such non-GAAP financial measures because management believes that they are useful both to management and investors as a supplement, and not as a substitute, when evaluating the Company’s operating performance. Additionally, management believes that adjusted EBITDA, adjusted EBITDA margin, adjusted net income, and adjusted diluted EPS serve as industry-wide financial measures. The Company uses adjusted EBITDA for making financial decisions, allocating resources and for determining certain incentive compensation objectives. The non-GAAP measures in this release are not in accordance with, or an alternative to, GAAP measures and may be different from non-GAAP measures, or may be calculated differently than other similarly titled non-GAAP measures, reported by other companies. They should not be used in isolation to evaluate the Company’s performance.  A reconciliation of non-GAAP measures identified in this release, along with further detail about the use and limitations of certain of these non-GAAP measures, may be found below in the table entitled “Non-GAAP Reconciliation Tables” under the caption entitled “Reconciliation of Non-GAAP Items” and the footnotes thereto or on the Company’s website at https://ir.amnhealthcare.com/financials/quarterly-results/default.aspx. Additionally, from time to time, additional information regarding non-GAAP financial measures, including pro forma measures, may be made available on the Company’s website.

Forward-Looking Statements

This press release contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include, among others, statements concerning our capital deployment strategy, the potential for acquisitions or stock repurchases, healthcare utilization, the duration and severity of the labor shortage, and the demand and supply imbalance of healthcare professionals, our position in technology-enabled total talent solutions, our ability to offer attractive work opportunities, our ability to develop new technology that will speed our operations, better integrate us with clients, or deliver tools that give clients and healthcare professionals more control and flexibility, our branding initiatives and their ability to add momentum to our sales pipeline and/or increase candidate traffic and applications, our ability to integrate MSDR and the results of such acquisition and integration, demand for our services, and our outlook for 2024 consolidated revenue, gross margin, SG&A expenses as a percentage of revenue, operating margin, adjusted EBITDA margin, first quarter year-over-year revenue performance for each of our Nurse and Allied, Physician and Leadership, and Technology and Workforce Solutions reporting segments, depreciation expense, stock-based compensation expense, interest expense, integration and other expenses, adjusted tax rate, amortization expense and weighted average diluted shares. In addition, the financial results set forth in this press release reflect the Company's current preliminary financial results prior to completion of the Company's audit process and are subject to change. The Company bases these forward-looking statements on its current expectations, estimates and projections about future events and the industry in which it operates using information currently available to it. Forward-looking statements are identified by words such as “believe,” “anticipate,” “expect,” “intend,” “plan,” “will,” “may,” “estimates,” variations of such words and other similar expressions. In addition, any statements that refer to expectations, projections or other characterizations of future events or circumstances are forward-looking statements. Actual results could differ materially from those discussed in, or implied by, these forward-looking statements as a result of a variety of factors, including consummating and incorporating acquisitions into our business, complying with extensive federal and state regulations related to the conduct of our operations, and continuing to recruit and retain sufficient quality healthcare professionals at reasonable costs.

The targets and expectations noted in this release depend upon, among other factors, (i) the magnitude and duration of the effects of the COVID-19 pandemic on demand trends, our business, its financial condition and our results of operations, (ii) the duration of the period that hospitals and other healthcare entities decrease their utilization of temporary employees, physicians, leaders and other workforce technology applications as a result of the suspension of or restrictions placed on non-essential and elective healthcare as a result of the COVID-19 pandemic, (iii) the duration of the period that individuals may continue to forego non-essential and elective healthcare as “safer at home” restrictions and recommendations lift, (iv) the extent to which the extent and duration challenging economic times will cause an increase in under- and uninsured patients and a corresponding reduction in overall healthcare utilization and demand for our services, (v) our ability to effectively address client demand by attracting and placing nurses and other clinicians, (vi) our ability to anticipate and quickly respond to changing marketplace conditions, such as alternative modes of healthcare delivery, reimbursement, or client needs, (vii) our ability to manage the pricing impact that the COVID-19 pandemic and consolidation of healthcare delivery organizations may have on our business, (viii) the extent to which challenging economic times will have on the financial condition and cash flow of many hospitals and healthcare systems such that it impairs their ability to make payments to us, timely or otherwise, for services rendered, (ix) our ability to recruit and retain sufficient quality healthcare professionals at reasonable costs (x) our ability to develop and evolve our current technology offerings and capabilities and implement new infrastructure and technology systems to optimize our operating results and manage our business effectively, (xiii) our ability to comply with extensive and complex federal and state laws and regulations related to the conduct of our operations, costs and payment for services and payment for referrals as well as laws regarding employment practices, and (xi) our ability to consummate and effectively incorporate acquisitions into our business.

For a discussion of additional risk factors and a more complete discussion of some of the cautionary statements noted above that could cause actual results to differ from those implied by the forward-looking statements contained in this press release, please refer to “Risk Factors” under Item 1A of our most recent Annual Report on Form 10-K for the year ended December 31, 2022, our subsequent Quarterly Reports on Form 10-Q and our Current Reports on Form 8-K. Be advised that developments subsequent to this press release are likely to cause these statements to become outdated and the Company is under no obligation (and expressly disclaims any such obligation) to update or revise any forward-looking statements whether as a result of new information, future events, or otherwise.

Contact:
Randle Reece
Senior Director, Investor Relations
866.861.3229


AMN Healthcare Services, Inc.
Condensed Consolidated Statements of Comprehensive Income
(in thousands, except per share amounts)
(unaudited)
 
 Three Months Ended Twelve Months Ended
 December 31, Sept 30, December 31,
  2023   2022   2023   2023   2022 
Revenue$818,269  $1,125,511  $853,463  $3,789,254  $5,243,242 
Cost of revenue 557,321   750,258   563,957   2,539,673   3,526,558 
Gross profit 260,948   375,253   289,506   1,249,581   1,716,684 
Gross margin 31.9%  33.3%  33.9%  33.0%  32.7%
Operating expenses:         
Selling, general and administrative (SG&A) 185,463   219,148   163,405   756,238   936,576 
SG&A as a % of revenue 22.7%  19.5%  19.1%  20.0%  17.9%
          
Depreciation and amortization (exclusive of depreciation included in cost of revenue) 41,315   36,838   39,175   154,914   133,007 
Total operating expenses 226,778   255,986   202,580   911,152   1,069,583 
Income from operations 34,170   119,267   86,926   338,429   647,101 
Operating margin (1) 4.2%  10.6%  10.2%  8.9%  12.3%
          
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FAQ

What was AMN Healthcare Services, Inc.'s quarterly revenue for Q4 2023?

AMN Healthcare Services, Inc. reported quarterly revenue of $818.3 million for Q4 2023.

What were the GAAP and adjusted EPS for AMN Healthcare Services, Inc. in Q4 2023?

AMN Healthcare Services, Inc. reported GAAP EPS of $0.33 and adjusted EPS of $1.32 for Q4 2023.

What were the key highlights of AMN Healthcare Services, Inc.'s financial results for 2023?

Despite revenue declines, key highlights include significant tech advancements, a large MSP client win, and recognition for workplace diversity.

How did the acquisition of MSDR impact AMN Healthcare Services, Inc.'s revenue?

The acquisition of MSDR boosted locum tenens revenue for AMN Healthcare Services, Inc.

What is AMN Healthcare Services, Inc.'s outlook for the first quarter of 2024?

AMN Healthcare Services, Inc. anticipates lower revenue in the first quarter of 2024, with Nurse and Allied Solutions segment revenue expected to be down 36-38% below the prior year.

What was AMN Healthcare Services, Inc.'s total debt outstanding at the end of 2023?

AMN Healthcare Services, Inc. ended 2023 with total debt outstanding of $1.31 billion and a net leverage ratio of 2.2 to 1.

AMN Healthcare Services, Inc.

NYSE:AMN

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