Provider First Line Business Practice Location Address:
1325 S EASTERN AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89104-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-241-4761
Provider Business Practice Location Address Fax Number:
702-227-7209
Provider Enumeration Date:
05/20/2020