Provider First Line Business Practice Location Address:
5300 W SAHARA AVE
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-0353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-248-6290
Provider Business Practice Location Address Fax Number:
702-248-4720
Provider Enumeration Date:
10/18/2008