Provider First Line Business Practice Location Address:
4700 NORTH LAS VEGAS BOULEVARD
Provider Second Line Business Practice Location Address:
MIKE O'CALLAGHAN FEDERAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
NELLIS AIR FORCE BASE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89191-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-653-3455
Provider Business Practice Location Address Fax Number:
702-653-3398
Provider Enumeration Date:
11/02/2005