Provider First Line Business Practice Location Address:
5576 S FORT APACHE RD. SUITE 120
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:
89148-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-895-9968
Provider Business Practice Location Address Fax Number:
702-895-9928
Provider Enumeration Date:
03/16/2006