Provider First Line Business Practice Location Address:
1580 E DESERT INN RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89169-2548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-836-3442
Provider Business Practice Location Address Fax Number:
702-836-9367
Provider Enumeration Date:
12/11/2012