Provider First Line Business Practice Location Address:
7473 W LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-562-7253
Provider Business Practice Location Address Fax Number:
702-562-8162
Provider Enumeration Date:
02/21/2011