Provider First Line Business Practice Location Address:
140 E ROME BLVD
Provider Second Line Business Practice Location Address:
1008
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-969-1861
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026