Provider First Line Business Practice Location Address:
2301 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-7137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-331-8338
Provider Business Practice Location Address Fax Number:
702-639-0579
Provider Enumeration Date:
11/30/2006