Provider First Line Business Practice Location Address:
1101 N DECATUR BLVD
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:
89108-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-813-9827
Provider Business Practice Location Address Fax Number:
702-642-4372
Provider Enumeration Date:
09/17/2010