Provider First Line Business Practice Location Address:
2400 N TENAYA WAY STE 114
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:
89128-0644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-648-6495
Provider Business Practice Location Address Fax Number:
702-991-6412
Provider Enumeration Date:
01/17/2025