Provider First Line Business Practice Location Address:
2208 S NELLIS BLVD STE 5
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:
89104-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-444-7524
Provider Business Practice Location Address Fax Number:
702-444-4135
Provider Enumeration Date:
09/02/2026