Provider First Line Business Practice Location Address:
6950 W DESERT INN RD STE 110
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:
89117-3171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
22-595-5507
Provider Business Practice Location Address Fax Number:
702-259-5554
Provider Enumeration Date:
02/23/2006