Provider First Line Business Practice Location Address:
2136 E DESERT INN RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-0802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-562-2420
Provider Business Practice Location Address Fax Number:
702-562-3202
Provider Enumeration Date:
08/25/2006