Provider First Line Business Practice Location Address: 
8352 W WARM SPRINGS RD STE 200
    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: 
89113-3629
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
702-330-0555
    Provider Business Practice Location Address Fax Number: 
702-832-1128
    Provider Enumeration Date: 
07/01/2011