Provider First Line Business Practice Location Address:
6140 SOUTH FORT APACHE ROAD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-655-8400
Provider Business Practice Location Address Fax Number:
702-255-8409
Provider Enumeration Date:
12/28/2006