Provider First Line Business Practice Location Address:
4100 N MARTIN L KING BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-0293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-522-7800
Provider Business Practice Location Address Fax Number:
702-974-1264
Provider Enumeration Date:
10/18/2010