Provider First Line Business Practice Location Address:
8225 W SAHARA AVE STE C-1
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:
89117-8962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-476-2899
Provider Business Practice Location Address Fax Number:
702-213-9001
Provider Enumeration Date:
08/16/2016