Provider First Line Business Practice Location Address:
5061 E SAHARA AVE
Provider Second Line Business Practice Location Address:
1A
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89142-2984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-641-8868
Provider Business Practice Location Address Fax Number:
702-641-8865
Provider Enumeration Date:
11/19/2009