Provider First Line Business Practice Location Address:
7670 W LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-6649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-312-2273
Provider Business Practice Location Address Fax Number:
702-312-2276
Provider Enumeration Date:
04/22/2008