Provider First Line Business Practice Location Address:
1500 E DESERT INN RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89169-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-862-8550
Provider Business Practice Location Address Fax Number:
702-892-8431
Provider Enumeration Date:
05/24/2011