Provider First Line Business Practice Location Address:
5740 S FORT APACHE RD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-527-3275
Provider Business Practice Location Address Fax Number:
702-441-0861
Provider Enumeration Date:
08/31/2016