Provider First Line Business Practice Location Address:
3399 S EASTERN AVE STE B
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:
89169-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
725-735-6904
Provider Business Practice Location Address Fax Number:
725-735-6907
Provider Enumeration Date:
03/05/2026