Provider First Line Business Practice Location Address:
2425 N LAMB BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89115-5420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-644-9155
Provider Business Practice Location Address Fax Number:
702-644-1255
Provider Enumeration Date:
12/14/2006