Provider First Line Business Practice Location Address:
912 W OWENS
Provider Second Line Business Practice Location Address:
VA OF SOUTHERN NEVADA
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-395-1447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006