Provider First Line Business Practice Location Address:
6134 W LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
E-8
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89108-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-631-4144
Provider Business Practice Location Address Fax Number:
702-631-9094
Provider Enumeration Date:
12/01/2005