Provider First Line Business Practice Location Address:
3025 E DESERT INN RD
Provider Second Line Business Practice Location Address:
SUITE #20
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-3856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-798-1112
Provider Business Practice Location Address Fax Number:
702-798-0209
Provider Enumeration Date:
11/07/2006