Provider First Line Business Practice Location Address:
4324 S EASTERN AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-6064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-823-1712
Provider Business Practice Location Address Fax Number:
702-478-8672
Provider Enumeration Date:
11/24/2009