Provider First Line Business Practice Location Address:
7140 SMOKE RANCH RD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-839-4825
Provider Business Practice Location Address Fax Number:
702-998-2198
Provider Enumeration Date:
10/31/2016