Provider First Line Business Practice Location Address:
1700 E DESERT INN RD STE 304B
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:
89169-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-560-9252
Provider Business Practice Location Address Fax Number:
702-442-8469
Provider Enumeration Date:
10/11/2018