Provider First Line Business Practice Location Address:
4700 NORTH LAS VEGAS BLVD.
Provider Second Line Business Practice Location Address:
NELLIS AIR FORCE BASE
Provider Business Practice Location Address City Name:
LAS VEGAS
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:
702-653-3172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2008