Provider First Line Business Practice Location Address:
3050 E DESERT INN RD STE 124
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:
89121-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-697-2105
Provider Business Practice Location Address Fax Number:
702-697-2107
Provider Enumeration Date:
09/22/2006