Provider First Line Business Practice Location Address:
5761 S FORT APACHE RD
Provider Second Line Business Practice Location Address:
BLDG. 8
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-341-6610
Provider Business Practice Location Address Fax Number:
702-341-6961
Provider Enumeration Date:
07/19/2005