Provider First Line Business Practice Location Address:
5920 S RAINBOW BLVD
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:
89118-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-919-7115
Provider Business Practice Location Address Fax Number:
702-819-3784
Provider Enumeration Date:
03/11/2026