Provider First Line Business Practice Location Address:
6990 SMOKE RANCH RD
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:
89128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-242-5155
Provider Business Practice Location Address Fax Number:
702-242-5150
Provider Enumeration Date:
08/30/2006