Provider First Line Business Practice Location Address:
3925 MARTIN LUTHER KING BLVD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
N. LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-444-0235
Provider Business Practice Location Address Fax Number:
702-992-3505
Provider Enumeration Date:
09/11/2026