Provider First Line Business Practice Location Address:
1640 E SAHARA AVE STE A
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:
89104-3491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
725-301-6617
Provider Business Practice Location Address Fax Number:
702-537-9104
Provider Enumeration Date:
01/19/2022