Provider First Line Business Practice Location Address:
5785 S FORT APACHE RD
Provider Second Line Business Practice Location Address:
STE. 100B
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-228-3111
Provider Business Practice Location Address Fax Number:
702-228-0411
Provider Enumeration Date:
01/23/2006