Provider First Line Business Practice Location Address:
6236 W DESERT INN RD STE 110
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:
89146-6612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-240-9002
Provider Business Practice Location Address Fax Number:
702-240-9008
Provider Enumeration Date:
12/26/2006