Provider First Line Business Practice Location Address: 
9540 W FLAMINGO RD
    Provider Second Line Business Practice Location Address: 
#140 #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: 
89147-5752
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
702-895-9000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/08/2014