Provider First Line Business Practice Location Address:
5825 W SAHARA AVE
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-433-4357
Provider Business Practice Location Address Fax Number:
702-222-1210
Provider Enumeration Date:
10/20/2010