Provider First Line Business Practice Location Address:
6120 S FORT APACHE RD STE 100
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:
89148-6760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-777-7879
Provider Business Practice Location Address Fax Number:
424-703-6659
Provider Enumeration Date:
10/28/2026