Provider First Line Business Practice Location Address:
3050 E DESERT INN RD STE 105
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:
89121-3871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-241-8206
Provider Business Practice Location Address Fax Number:
702-894-4175
Provider Enumeration Date:
02/19/2007