Provider First Line Business Practice Location Address:
8488 ROZITA LEE AVE
Provider Second Line Business Practice Location Address:
BLDG 3 SUITE 100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89113-4772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-518-2384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2026