Provider First Line Business Practice Location Address:
8240 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-9088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-220-7633
Provider Business Practice Location Address Fax Number:
702-240-8052
Provider Enumeration Date:
12/14/2005