Provider First Line Business Practice Location Address:
1414 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
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:
89036-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-664-7318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2026