Provider First Line Business Practice Location Address:
2785 E. DESERT INN RD
Provider Second Line Business Practice Location Address:
STE 230
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-931-1561
Provider Business Practice Location Address Fax Number:
702-912-0188
Provider Enumeration Date:
08/19/2013