Provider First Line Business Practice Location Address:
2755 E DESERT INN RD STE 180
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:
89121-3694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-765-5000
Provider Business Practice Location Address Fax Number:
702-765-5003
Provider Enumeration Date:
12/30/2019