Provider First Line Business Practice Location Address:
4550 E CHARLESTON BOULVARD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-475-4352
Provider Business Practice Location Address Fax Number:
702-356-8971
Provider Enumeration Date:
01/07/2026