Provider First Line Business Practice Location Address:
3050 EAST DESERT ROAD
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-796-0660
Provider Business Practice Location Address Fax Number:
702-796-1835
Provider Enumeration Date:
10/23/2006