Provider First Line Business Practice Location Address:
2550 E DESERT INN RD
Provider Second Line Business Practice Location Address:
SUITE #278
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-340-1144
Provider Business Practice Location Address Fax Number:
702-215-6395
Provider Enumeration Date:
08/29/2012