Provider First Line Business Practice Location Address:
6460 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
STE. 150
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-868-2781
Provider Business Practice Location Address Fax Number:
702-868-2782
Provider Enumeration Date:
11/14/2006